Provider Demographics
NPI:1932381803
Name:PAVLIK, KENNETH KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KEVIN
Last Name:PAVLIK
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 1:306 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERDIGRE
Mailing Address - State:NE
Mailing Address - Zip Code:68783-6163
Mailing Address - Country:US
Mailing Address - Phone:402-668-2332
Mailing Address - Fax:
Practice Address - Street 1:306 7TH AVE
Practice Address - Street 2:
Practice Address - City:VERDIGRE
Practice Address - State:NE
Practice Address - Zip Code:68783-6163
Practice Address - Country:US
Practice Address - Phone:402-668-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069839300Medicaid
NEB68014Medicare UPIN
NE47069839300Medicaid