Provider Demographics
NPI:1699886028
Name:OHLSON, CORY L (MD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:L
Last Name:OHLSON
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 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-7142
Practice Address - Fax:402-219-8961
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590117Medicaid
NE232041OtherMIDLAND'S CHOICE
NE470780857 34Medicaid
NE39-00500OtherUHC
NE34195OtherBCBS
IA0590117Medicaid
280745Medicare PIN
G98979Medicare UPIN