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General NPI Number Information
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NPI Number | 1265657969
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Entity Type | Organization
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Legal Business Name | EUGENE VITVITSKY MD
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2046 BURKE LANE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406
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Country | US
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Telephone | 928-855-4411
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Fax | 928-855-4418
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Provider Business Mailing Address
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Address Line | 1845 MCCOLLOCH BLVD SUITE A-2
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403
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Country | US
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Telephone | 928-855-4411
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Fax | 928-855-4418
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. EUGENE VITVITSKY
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Credential | M.D.
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Telephone | 928-855-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35142
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License Number State | AZ
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