Basic Information
| Provider Information | |||||||||
| NPI: | 1093764896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUCITI | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6911 VAN DORN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685066801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Practice Location | |||||||||
| Address1: | 6911 VAN DORN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685066801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 23575 | NE | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 470619798-13 | 05 | NE | MEDICAID |