Healthcare Provider Details

I. General information

NPI: 1518457456
Provider Name (Legal Business Name): SVEN KEVIN IVANKOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 KING AVENUE STE 150
ATHENS GA
30606
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-1870
  • Fax:
Mailing address:
  • Phone: 314-362-3577
  • Fax: 314-362-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2025012590
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number112061
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: