Provider Demographics
NPI:1194728915
Name:TENNITY, JOHN J (DPM)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:TENNITY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1150 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2094
Mailing Address - Country:US
Mailing Address - Phone:402-483-4485
Mailing Address - Fax:402-483-5372
Practice Address - Street 1:1150 N 83RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2094
Practice Address - Country:US
Practice Address - Phone:402-483-4485
Practice Address - Fax:402-483-5372
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083655807Medicaid
NE48033679OtherRAILROAD MEDICARE
NE2572OtherBLUE CROSS BLUE SHIELD ID
NE27-00182OtherUNITED HEALTHCARE ID
NE47083655807Medicaid
NE0455960001Medicare NSC
NE2572OtherBLUE CROSS BLUE SHIELD ID