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NPI Code Detail

MEDICARE: BRIAN HAVEL DMD

MEDICARE: BRIAN HAVEL DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019032234IL

General Provider Information

NPI Number : 1205488400
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN HAVEL DMD
Provider Business Mailing Address
First Line : 2829 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6932
Country : US
Telephone Number : 773-528-8900
Fax Number :
Provider Business Practice Location Address
First Line : 2829 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6932
Country : US
Telephone Number : 773-528-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2019
Last Update Date : 07/09/2019

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