MEDICARE: DR. IVAN CVIK MD

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	207R00000X	Internal Medicine Physician	ME 87823	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578505905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN CVIK MD

Provider Business Mailing Address
First Line	:	13831 METROPOLIS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912
Country	:	US
Telephone Number	:	239-466-6855
Fax Number	:	239-466-6833

Provider Business Practice Location Address
First Line	:	13831 METROPOLIS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4452
Country	:	US
Telephone Number	:	239-466-6855
Fax Number	:	239-466-6833

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/12/2009

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