Provider Demographics
NPI:1336701689
Name:MAGLIULO, ERIC KEONI (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:KEONI
Last Name:MAGLIULO
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 1:1111 N 102ND CT STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2194
Mailing Address - Country:US
Mailing Address - Phone:024-502-2747
Mailing Address - Fax:402-502-2387
Practice Address - Street 1:1111 N 102ND CT STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2194
Practice Address - Country:US
Practice Address - Phone:024-502-2747
Practice Address - Fax:402-502-2387
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8628207R00000X
IAMD-53112207RN0300X
NE36286207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine