Basic Information
| Provider Information | |||||||||
| NPI: | 1538149257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACKERMAN | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7440 S 91ST ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685269797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024896555 | ||||||||
| FaxNumber: | 4023283770 | ||||||||
| Practice Location | |||||||||
| Address1: | 7440 S 91ST ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685269797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024896555 | ||||||||
| FaxNumber: | 4023283770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 21011 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | 21011 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 10026072400 | 05 | NE | MEDICAID | 47070592300 | 05 | NE | MEDICAID | 47070592305 | 05 | NE | MEDICAID | 10026072500 | 05 | NE | MEDICAID | 10026072200 | 05 | NE | MEDICAID | 10026072300 | 05 | NE | MEDICAID | 10026072600 | 05 | NE | MEDICAID | 47070592302 | 05 | NE | MEDICAID | O537043 | 05 | IA | MEDICAID | 100350900A | 05 | NE | MEDICAID | 10026072000 | 05 | NE | MEDICAID | 47070592301 | 05 | NE | MEDICAID | 47070592306 | 05 | NE | MEDICAID | 47070592313 | 05 | NE | MEDICAID |