Provider Demographics
NPI:1538249404
Name:HALVONIK, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:HALVONIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10496 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5220
Mailing Address - Country:US
Mailing Address - Phone:513-793-2654
Mailing Address - Fax:513-793-2962
Practice Address - Street 1:10496 MONTGOMERY ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5220
Practice Address - Country:US
Practice Address - Phone:513-793-2654
Practice Address - Fax:513-793-2962
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35048417207RC0200X
OH35048417207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
48417OtherHUMANA
P00164532OtherRAILROAD MEDICARE
OH0664759Medicaid
0004091204OtherAETNA
0402518OtherUNITED HEALTHCARE
000000244057OtherANTHEM
OH0664759Medicaid
A83077Medicare UPIN