Basic Information
Provider Information | |||||||||
NPI: | 1861500696 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DESAI | ||||||||
FirstName: | ALKA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BUECHLER | ||||||||
OtherFirstName: | ALKA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 8401 W DODGE RD | ||||||||
Address2: | SUITE 280 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681143451 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4029556877 | ||||||||
FaxNumber: | 4029556880 | ||||||||
Practice Location | |||||||||
Address1: | 13808 W MAPLE RD | ||||||||
Address2: | SUITE 100 | ||||||||
City: | OMAHA | ||||||||
State: | NE | ||||||||
PostalCode: | 681646231 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4029553000 | ||||||||
FaxNumber: | 4029557055 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/29/2006 | ||||||||
LastUpdateDate: | 01/31/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 19797 | NE | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 5069 | 01 | NE | MIDLANDS CHOICE | OTHER | 1200199 | 01 | NE | SHARE ADVANTAGE | OTHER | 31411 | 01 | NE | BCBS | OTHER | 47068937200 | 05 | NE |   | MEDICAID | 982231 | 05 | IA |   | MEDICAID | 93424 | 01 | IA | BCBS | OTHER |