Provider Demographics
NPI:1851853253
Name:GERLITZ, IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:GERLITZ
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 1:309 BEASLEY ST
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:BC
Mailing Address - Zip Code:V1L 5M5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 BEASLEY ST
Practice Address - Street 2:
Practice Address - City:NELSON
Practice Address - State:BC
Practice Address - Zip Code:V1L 5M5
Practice Address - Country:CA
Practice Address - Phone:360-972-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program