Provider Demographics
NPI:1477507804
Name:MIHALEVICH, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:MIHALEVICH
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 1:3800 S. NATIONAL AVE
Mailing Address - Street 2:STE. 540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5284
Mailing Address - Country:US
Mailing Address - Phone:417-269-8825
Mailing Address - Fax:417-269-8744
Practice Address - Street 1:1423 N. JEFFERSON
Practice Address - Street 2:#B100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-1917
Practice Address - Country:US
Practice Address - Phone:417-269-8825
Practice Address - Fax:417-269-8744
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
17677OtherBLUE CROSS MO
MO200946614Medicaid
17677OtherBLUE CROSS MO
964420038Medicare PIN
MO200946614Medicaid
MOA27927Medicare UPIN