Healthcare Provider Details

I. General information

NPI: 1013152404
Provider Name (Legal Business Name): DR SLOVACHEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2008
Last Update Date: 12/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE
EVANSVILLE IN
47750-0001
US

IV. Provider business mailing address

1877 LAKES EDGE DR
NEWBURGH IN
47630-8091
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-7111
  • Fax: 812-485-7070
Mailing address:
  • Phone: 812-490-4610
  • Fax: 812-490-4610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01056372
License Number StateIN

VIII. Authorized Official

Name: DR. DONN RICHARD SLOVACHEK
Title or Position: MANAGER
Credential: MD
Phone: 812-490-4610