Provider Demographics
NPI:1053799486
Name:POPOVICH, JAMES KENNETH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:POPOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:KENNETH
Other - Last Name:PUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 POLE CREEK CROSSING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2900
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:
Practice Address - Street 1:1000 POLE CREEK XING STE 1
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2902
Practice Address - Country:US
Practice Address - Phone:308-254-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31424207Q00000X
WV28377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine