MEDICARE: MR. MIKE E. PELIVANIS LDO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1407997992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIKE E. PELIVANIS LDO

Provider Business Mailing Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	202-244-1308
Fax Number	:	202-244-2050

Provider Business Practice Location Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	202-244-1308
Fax Number	:	202-244-2050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

Similar Medicare Providers

1043673916 — THUY NGUYEN M.D.
Practice Location Address:

4200 WISCONSIN AVE NW STE 4
WASHINGTON, DC
20016-2143

Practice Phone: 202-243-3400
Practice Fax: 202-243-3434

1760469415 — MR. BRUCE ALLEN HERR JR. CRNA
Practice Location Address:

4200 WISCONSIN AVE NW , STE 106-152
WASHINGTON, DC
20016-2143

Practice Phone: 202-963-1703
Practice Fax:

1124061510 — DR. JOHN RICHARD REILLY M.D.
Practice Location Address:

4200 WISCONSIN AVE NW , #223
WASHINGTON, DC
20016-2143

Practice Phone: 202-466-1800
Practice Fax: 202-452-1542

1326163320 — DR. JESSICA EXELBERT RUBIN DDS
Practice Location Address:

4200 WISCONSIN AVE NW , SUITE 240
WASHINGTON, DC
20016-2143

Practice Phone: 202-545-7200
Practice Fax: 202-545-7220

1033325881 — DR. ROBERT SEAN MCDONOUGH M.D.
Practice Location Address:

4200 WISCONSIN AVE NW , PMB 106-204
WASHINGTON, DC
20016-2143

Practice Phone: 860-273-0123
Practice Fax: 860-262-9466

1811199383 — PAOLA PERGAMI MD
Practice Location Address:

4200 WISCONSIN AVE NW
WASHINGTON, DC
20016-2143

Practice Phone: 202-817-7658
Practice Fax:

Directions to “ MR. MIKE E. PELIVANIS LDO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.