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NPI Code Detail

MEDICARE: DR. KEVIN LORAS HAVLIK MD

MEDICARE: DR. KEVIN LORAS HAVLIK MD
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
1208000000XPediatrics Physician1670191205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558315796
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN LORAS HAVLIK MD
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-464-7600
Fax Number : 801-464-7656
Provider Business Practice Location Address
First Line : 2000 S 900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84105-3208
Country : US
Telephone Number : 801-464-7600
Fax Number : 801-464-7656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 06/26/2009

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