Provider Demographics
NPI:1912029141
Name:HORVATH, PAUL RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:HORVATH
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:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54702-1510
Mailing Address - Country:US
Mailing Address - Phone:175-838-5222
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5222
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083984207P00000X
WI51625207P00000X
AZ50155207P00000X
MN58776207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35381500Medicaid
MIPH083984OtherBLUE CROSS BLUE SHIELD
MI5217656-10Medicaid
MI105187510Medicaid
MIG56008-149Medicare PIN
MI230015Medicare Oscar/Certification
MIPH083984OtherBLUE CROSS BLUE SHIELD
MI5217656-10Medicaid
WI35381500Medicaid