Basic Information
| Provider Information | |||||||||
| NPI: | 1508003914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIVEKANANDAN | ||||||||
| FirstName: | RENUGA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 DOUGLAS ST | ||||||||
| Address2: | 503 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681021860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125439940 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF NEBRASKA | ||||||||
| Address2: | 982055 NEBRASKA MEDICAL CENTER | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681980001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025597792 | ||||||||
| FaxNumber: | 4025599385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 01/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5613 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.