Basic Information
| Provider Information | |||||||||
| NPI: | 1285049197 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MADAN | ||||||||
| FirstName: | NIDHI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3755 | ||||||||
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| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681030755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023542100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 N 103RD PLZ STE 100 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681141119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023915055 | ||||||||
| FaxNumber: | 4023915053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036.142308 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0011X | 34626 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.