Basic Information
| Provider Information | |||||||||
| NPI: | 1558495986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVLIK | ||||||||
| FirstName: | ROSTISLAV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1236 E ELIZABETH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702242985 | ||||||||
| FaxNumber: | 9704729381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1236 E ELIZABETH ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702242985 | ||||||||
| FaxNumber: | 9704729381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 09/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 44649 | CO | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA08128500 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35406 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | A96373 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 238208-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 8281A | WY | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 08871337 | 05 | CO | MEDICAID |