Provider Demographics
NPI:1104991116
Name:DAVEY, KURT A (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:A
Last Name:DAVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 BURKE STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:
Practice Address - Street 1:18018 BURKE STREET
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4417
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20334208000000X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1200245Medicaid
NE1200594Medicaid
NE1200595Medicaid
NE1201172Medicaid
NE31665OtherBCBS OF NE
NE4721OtherMIDLANDS CHOICE
MI10-4764149Medicaid
NE1200232Medicaid
MI10-4902764Medicaid
NE1200246Medicaid
NE1201453Medicaid
IA1969915Medicaid
IA296915Medicaid
IA0969915Medicaid
MI10-4764120Medicaid
MI10-4902764Medicaid