Healthcare Provider Details

I. General information

NPI: 1295045433
Provider Name (Legal Business Name): OLIVER A. CVITANIC MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SW 80TH ST
OKLAHOMA CITY OK
73139-8107
US

IV. Provider business mailing address

PO BOX 12746
OKLAHOMA CITY OK
73157-2746
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-8405
  • Fax: 405-634-8709
Mailing address:
  • Phone: 405-607-1325
  • Fax: 405-607-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16587
License Number StateOK

VIII. Authorized Official

Name: DR. OLIVER ANTHONY CVITANIC
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-634-8405