Provider Demographics
NPI:1528063930
Name:LITTLE, JONATHAN MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:LITTLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 HARLAN DR.
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005
Mailing Address - Country:US
Mailing Address - Phone:402-291-3123
Mailing Address - Fax:
Practice Address - Street 1:1313 HARLAN DR.
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005
Practice Address - Country:US
Practice Address - Phone:402-291-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE186213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080166000Medicaid
NE02566OtherBLUE CROSS BLUE SHIELD
0360620001Medicare NSC
NE02566OtherBLUE CROSS BLUE SHIELD
NE267955Medicare ID - Type Unspecified