MEDICARE: LOU V. IVANOVIC M.D., FACC

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	207RC0000X	Cardiovascular Disease Physician	62323	AZ

General Provider Information

NPI Number	:	1245220730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOU V. IVANOVIC M.D., FACC

Provider Business Mailing Address
First Line	:	3805 E BELL RD STE 3100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2136
Country	:	US
Telephone Number	:	602-494-3656
Fax Number	:	602-867-3862

Provider Business Practice Location Address
First Line	:	3805 E BELL RD STE 3100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2136
Country	:	US
Telephone Number	:	602-867-8644
Fax Number	:	602-606-5128

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/19/2022

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