Provider Demographics
NPI:1144338872
Name:MAHLOCH, MARK L (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:MAHLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:625 SOUTH PINE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:NE
Practice Address - Zip Code:68064
Practice Address - Country:US
Practice Address - Phone:402-359-2277
Practice Address - Fax:402-359-5432
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068731761Medicaid
NE275064Medicaid
IA1144338872Medicaid
NE47068731761Medicaid