Provider Demographics
NPI:1760485544
Name:HAVEKOST, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:HAVEKOST
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 1:105 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4002
Mailing Address - Country:US
Mailing Address - Phone:402-520-7302
Mailing Address - Fax:402-520-7303
Practice Address - Street 1:105 S 9TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4002
Practice Address - Country:US
Practice Address - Phone:402-520-7302
Practice Address - Fax:402-520-7303
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE089888Medicare ID - Type Unspecified
NEE50023Medicare UPIN