Healthcare Provider Details

I. General information

NPI: 1144868019
Provider Name (Legal Business Name): PAVEL SVINTOZELSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5083 COMMERCIAL DR
COLUMBIA MO
65203-7291
US

IV. Provider business mailing address

5083 COMMERCIAL DR
COLUMBIA MO
65203-7291
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-1170
  • Fax:
Mailing address:
  • Phone: 573-279-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2018038214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: