Provider Demographics
NPI:1336176494
Name:HAVLICHEK, DANIEL HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HARRY
Last Name:HAVLICHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:ROOM A205
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7037
Mailing Address - Country:US
Mailing Address - Phone:517-353-4830
Mailing Address - Fax:
Practice Address - Street 1:4650 S HAGADORN RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5386
Practice Address - Country:US
Practice Address - Phone:517-353-4830
Practice Address - Fax:517-355-2134
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045617207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336176494Medicaid
MI1732419Medicaid
MAB45403Medicare UPIN
MI1336176494Medicaid