MEDICARE: ANNA SPIVAK D.O.

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	208C00000X	Colon & Rectal Surgery Physician	34.015433	OH

General Provider Information

NPI Number	:	1801216106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA SPIVAK D.O.

Provider Business Mailing Address
First Line	:	9500 E 100TH STREET A30
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-445-7330
Fax Number	:	216-445-8627

Provider Business Practice Location Address
First Line	:	9500 E 100 ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3431
Country	:	US
Telephone Number	:	216-445-7330
Fax Number	:	216-445-8627

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

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/08/2022

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