Provider Demographics
NPI:1093876443
Name:HAVLIK, NANCY LYON (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYON
Last Name:HAVLIK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-0424
Mailing Address - Country:US
Mailing Address - Phone:317-733-7546
Mailing Address - Fax:317-733-4155
Practice Address - Street 1:55 BRENDON WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1961
Practice Address - Country:US
Practice Address - Phone:317-733-7546
Practice Address - Fax:317-733-4155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041675207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF69033Medicare UPIN
IN183820Medicare ID - Type Unspecified