Individual
KENNETH KEVIN PAVLIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
306 7TH AVE, VERDIGRE, NE 68783-6163
(402) 668-2332
Mailing address
306 7TH AVE, VERDIGRE, NE 68783-6163
(402) 668-2332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10400
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47069839300
—
NE
Enumeration date
12/03/2007
Last updated
12/03/2007
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