Provider Demographics
NPI:1558358143
Name:HAVEL, CHARLES J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:HAVEL
Suffix:JR
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 1:1323 PAR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-6409
Mailing Address - Country:US
Mailing Address - Phone:239-395-1044
Mailing Address - Fax:
Practice Address - Street 1:1500 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4835
Practice Address - Country:US
Practice Address - Phone:239-368-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31212207PP0204X
FLME99856207P00000X
IL207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE89673Medicare UPIN
WI73601Medicare ID - Type Unspecified