Provider Demographics
NPI:1215258421
Name:DR KATHRYN HAJJ MD PC
Entity type:Organization
Organization Name:DR KATHRYN HAJJ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-488-4861
Mailing Address - Street 1:4535 NORMAL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2891
Mailing Address - Country:US
Mailing Address - Phone:402-488-4861
Mailing Address - Fax:402-488-4864
Practice Address - Street 1:4535 NORMAL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2891
Practice Address - Country:US
Practice Address - Phone:402-488-4861
Practice Address - Fax:402-488-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE202522081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280502Medicare PIN