Individual
MARC HAVLICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-6583
(417) 269-6573
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
(417) 730-6430
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
20230212235
MO
Other
Enumeration date
04/12/2023
Last updated
04/30/2026
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