Provider Demographics
NPI:1932173770
Name:CIMINO, PETER MONACO (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MONACO
Last Name:CIMINO
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 1:11704 W CENTER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4375
Mailing Address - Country:US
Mailing Address - Phone:402-691-0500
Mailing Address - Fax:402-505-6249
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-691-0500
Practice Address - Fax:402-505-6249
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16362207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0755OtherBCBS PROVIDER NUMBER
IA0937078Medicaid
NE470533149212Medicaid
NE16362OtherNE MEDICAL LICENSE
NE093431OtherNE MEDICARE GROUP
NECJ6643OtherRR MEDICARE GROUP
IA09283Medicaid
NE2000-10322OtherRR MEDICARE
NE2000-10322OtherRR MEDICARE
IA0937078Medicaid
IA09283Medicaid