Basic Information
| Provider Information | |||||||||
| NPI: | 1154486306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUGHTAI | ||||||||
| FirstName: | WASIM | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2222 S 16TH ST | ||||||||
| Address2: | SUITE 400A | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685023796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024838590 | ||||||||
| FaxNumber: | 4024838599 | ||||||||
| Practice Location | |||||||||
| Address1: | 6900 VAN DORN ST | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685062882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024893200 | ||||||||
| FaxNumber: | 4024895101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 19785 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0400302 | 01 | NE | UHC | OTHER | 10026311700 | 05 | NE | MEDICAID | 1714 | 01 | NE | BCBS | OTHER | 470812081 | 01 | NE | TAX ID | OTHER | 080124010 | 01 | NE | RAILROAD MEDICARE | OTHER | 47081208100 | 05 | NE | MEDICAID | 470812081 | 01 | NE | COMMERCIAL INS | OTHER |