Provider Demographics
NPI:1356352256
Name:PACE, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PACE
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:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:402-421-3240
Mailing Address - Fax:402-423-0739
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-421-3240
Practice Address - Fax:402-423-0739
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE04-00765OtherUHC
IA0726315Medicaid
NE04203OtherBCBS
NE35448OtherBCBS
NE91182900813Medicaid
NE11244OtherMIDLAND'S CHOICE
NE04-00765OtherUHC
NE35448OtherBCBS
IA0726315Medicaid
NE110221334Medicare PIN
NE11244OtherMIDLAND'S CHOICE