Provider Demographics
NPI:1124079819
Name:FIKSINSKI, EDMUND O (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:O
Last Name:FIKSINSKI
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:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:1120 N 103RD PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1114
Practice Address - Country:US
Practice Address - Phone:402-391-5055
Practice Address - Fax:402-384-4202
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24213207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264481-00Medicaid
IA1124079819Medicaid
NE099099222Medicare PIN
MN060001378Medicare ID - Type UnspecifiedMNMD #-FOSS
ND060066781Medicare ID - Type UnspecifiedRAILROAD MEDICARE #-JAMES
MN060001381Medicare ID - Type UnspecifiedMNMD #-PRK RAP
ND11472Medicaid
NDG06819Medicare UPIN
MN060001379Medicare ID - Type UnspecifiedMNMD #-TRF
MN060066779Medicare ID - Type UnspecifiedRAILROAD MEDICARE #-FOSS
NE47076868513Medicaid
MN882983700Medicaid
ND060063021Medicare ID - Type UnspecifiedRAILROAD MEDICARE #-FGO
MN060066778Medicare ID - Type UnspecifiedRAILROAD MEDICARE #-DL
NE281556Medicare PIN
ND081D2FIOtherMNBS #-FGO/INN
NDDA9011026966OtherFGO/INN PREF 1 #
MN060066780Medicare ID - Type UnspecifiedRAILROAD MEDICARE #-PR
MN060001380Medicare ID - Type UnspecifiedMNMD #-DL
ND2500494OtherMEDICA ID-INN #