Healthcare Provider Details

I. General information

NPI: 1760485544
Provider Name (Legal Business Name): MICHAEL C HAVEKOST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 9TH ST
BEATRICE NE
68310-4002
US

IV. Provider business mailing address

105 S 9TH ST
BEATRICE NE
68310-4002
US

V. Phone/Fax

Practice location:
  • Phone: 402-520-7302
  • Fax: 402-520-7303
Mailing address:
  • Phone: 402-520-7302
  • Fax: 402-520-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18021
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: