Healthcare Provider Details

I. General information

NPI: 1124641212
Provider Name (Legal Business Name): PAVEL MEDVED DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W HAY ST STE 111
DECATUR IL
62526-6329
US

IV. Provider business mailing address

304 W HAY ST STE 111
DECATUR IL
62526-6329
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-1560
  • Fax:
Mailing address:
  • Phone: 217-876-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101027479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: