Basic Information
| Provider Information | |||||||||
| NPI: | 1558770743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUAISHA | ||||||||
| FirstName: | HAITAM | ||||||||
| MiddleName: | MOHAMAD | ||||||||
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| Credential: | MBBCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7261 MERCY RD DEPT OF | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242311 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7710 MERCY RD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027179800 | ||||||||
| FaxNumber: | 4027176068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 7174 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 32530 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.