Healthcare Provider Details

I. General information

NPI: 1932561495
Provider Name (Legal Business Name): TOMMY IVANICS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 AURORA CT
AURORA CO
80045-2517
US

IV. Provider business mailing address

1635 AURORA CT
AURORA CO
80045-2517
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0833
  • Fax:
Mailing address:
  • Phone: 917-862-8424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number0077980
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0077980
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: