Provider Demographics
NPI:1578505905
Name:CVIK, IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:CVIK
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 1:13831 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 87823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2678683 00Medicaid
FL2678683 00Medicaid
FL71029Medicare PIN