Individual
ERIC J VAN DE GRAAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 N 103RD PLZ STE 100, OMAHA, NE 68114-1119
(402) 391-5055
(402) 391-5053
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
22853
NE
207RC0000X
Cardiovascular Disease Physician
35616
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05581066
MEDICAID
IA
01
—
200262110A
MEDICAID
KS
05
—
47070592313
—
NE
01
—
I12883
MEDICARE
IA
Enumeration date
10/31/2006
Last updated
09/18/2025
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