MEDICARE: DR. MICHAEL C HAVEKOST M.D.

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
1	207Q00000X	Family Medicine Physician	18021	NE

General Provider Information

NPI Number	:	1760485544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C HAVEKOST M.D.

Provider Business Mailing Address
First Line	:	105 S 9TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-4002
Country	:	US
Telephone Number	:	402-520-7302
Fax Number	:	402-520-7303

Provider Business Practice Location Address
First Line	:	105 S 9TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-4002
Country	:	US
Telephone Number	:	402-520-7302
Fax Number	:	402-520-7303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/12/2023

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