Provider Demographics
NPI:1649238932
Name:SLAVIK, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SLAVIK
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 1:2825 HUNTERS TRL
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-3429
Mailing Address - Country:US
Mailing Address - Phone:608-742-7161
Mailing Address - Fax:608-745-3060
Practice Address - Street 1:2825 HUNTERS TRL
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3429
Practice Address - Country:US
Practice Address - Phone:608-742-7161
Practice Address - Fax:608-745-3060
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20442-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI339OtherDEAN HEALTH INSURANCE
WI1000292OtherPHYSICIANS PLUS
WI30108100Medicaid
B56668Medicare UPIN
WI339OtherDEAN HEALTH INSURANCE
WI110151933Medicare PIN