Provider Demographics
NPI:1508056110
Name:PAVELKA, CHRISTOPHER DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:PAVELKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:DANIEL
Other - Last Name:PAVELKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-882-3280
Mailing Address - Fax:812-885-3459
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-882-3280
Practice Address - Fax:812-885-3459
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003245A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200882790Medicaid
868110OtherHEALTHLINKS
02003245AOtherSTATE LICENSE
INP00670406OtherRAILROAD MEDICARE
IN000000599359OtherANTHEM
IN200882790Medicaid