Provider Demographics
NPI:1528061462
Name:NORRIS, R MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:R MICHAEL
Middle Name:
Last Name:NORRIS
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 1:1001 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-7901
Mailing Address - Country:US
Mailing Address - Phone:402-441-4760
Mailing Address - Fax:402-441-4764
Practice Address - Street 1:1001 S 70TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-441-4760
Practice Address - Fax:402-441-4764
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100310060BMedicaid
NE170036OtherUHC
NE30119OtherBCBS
P00321415OtherRRM
IA1714238Medicaid
NE1239OtherMIDLANDS
MO203605712Medicaid
NE68510A003OtherWPS/TRIWEST
NED90046Medicare UPIN
KS100310060BMedicaid