Provider Demographics
NPI:1194476051
Name:PAVLIK, TREVOR EARL
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:EARL
Last Name:PAVLIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5919 S 98TH PLZ APT 3B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3297
Mailing Address - Country:US
Mailing Address - Phone:402-659-7950
Mailing Address - Fax:
Practice Address - Street 1:5919 S 98TH PLZ. APT. 3B
Practice Address - Street 2:GARAGE 166
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-6812
Practice Address - Country:US
Practice Address - Phone:402-659-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor