Provider Demographics
NPI:1134293566
Name:HLAVATY, TODD E (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:HLAVATY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6525
Mailing Address - Country:US
Mailing Address - Phone:308-696-7741
Mailing Address - Fax:
Practice Address - Street 1:601 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6525
Practice Address - Country:US
Practice Address - Phone:308-696-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-18
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE200652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE31320OtherBLUE CROSS BLUE SHIELD
NE4983OtherMIDLANDS CHOICE
NE56138797001Medicaid
NE920007620OtherMEDICARE RAILROAD
NE920007620OtherMEDICARE RAILROAD
NEG31684Medicare UPIN