MEDICARE: DR. MICHAEL C TIVNON M.D.

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	207X00000X	Orthopaedic Surgery Physician	A24851	CA

General Provider Information

NPI Number	:	1447241138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C TIVNON M.D.

Provider Business Mailing Address
First Line	:	300 OLD RIVER RD
Second Line	:	SUITE 150
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-9503
Country	:	US
Telephone Number	:	661-663-7600
Fax Number	:	661-663-7676

Provider Business Practice Location Address
First Line	:	300 OLD RIVER RD
Second Line	:	SUITE 150
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-9503
Country	:	US
Telephone Number	:	661-663-7600
Fax Number	:	661-663-7676

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/09/2007

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