Healthcare Provider Details

I. General information

NPI: 1649238932
Provider Name (Legal Business Name): PAUL J SLAVIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 HUNTERS TRL 1ST FLOOR
PORTAGE WI
53901-3429
US

IV. Provider business mailing address

2825 HUNTERS TRL
PORTAGE WI
53901-3429
US

V. Phone/Fax

Practice location:
  • Phone: 608-742-7161
  • Fax: 608-745-3060
Mailing address:
  • Phone: 608-742-7161
  • Fax: 608-745-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20442-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: