Provider Demographics
NPI:1104243492
Name:IVAN CVIK, MD, P.A.
Entity type:Organization
Organization Name:IVAN CVIK, MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CVIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-466-6855
Mailing Address - Street 1:13831 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4452
Mailing Address - Country:US
Mailing Address - Phone:239-466-6855
Mailing Address - Fax:239-466-6833
Practice Address - Street 1:13831 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4452
Practice Address - Country:US
Practice Address - Phone:239-466-6855
Practice Address - Fax:239-466-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG35640Medicare UPIN