Provider Demographics
NPI:1194753806
Name:SLAVIN, MICHAEL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 510
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5690
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA3179207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7179416Medicaid
IA7179416Medicaid
IAC54321Medicare UPIN