Individual
SIDA NIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10707 PACIFIC ST STE 101, OMAHA, NE 68114-4762
(402) 397-7989
(402) 397-8703
Mailing address
10707 PACIFIC ST STE 101, OMAHA, NE 68114-4762
(402) 397-9800
(402) 397-7591
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
34554
NE
Other
Enumeration date
05/05/2017
Last updated
12/12/2025
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