Healthcare Provider Details

I. General information

NPI: 1629023221
Provider Name (Legal Business Name): ROBERT J. HAVLIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MAYFAIR RD PLASTIC SURGERY CENTER
MILWAUKEE WI
53226-3462
US

IV. Provider business mailing address

1155 N MAYFAIR RD PLASTIC SURGERY CENTER
MILWAUKEE WI
53226-3462
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-1000
  • Fax: 414-955-0183
Mailing address:
  • Phone: 414-955-1000
  • Fax: 414-955-0183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number01041790A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number60859
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: