Fomitchev, Ivan
Fomitchev, Ivan is an individual health care provider with primary practice located at 8711 Wales Reserve , San Antonio TX 78255-3371. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Fomitchev, Ivan can be contacted via phone (563) 564-1283.Contact Information
Primary practice address
8711 Wales Reserve
San Antonio TX 78255-3371
Phone: (563) 564-1283
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Pain Medicine | 208VP0000X | 34875 | Iowa |
Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 34875 | Iowa |
Profile Details
NPI number | 1699742312 |
---|---|
LBN Legal business name | Fomitchev, Ivan |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 1st, 2006 |
Last updated | May 19th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1699742312 | NPPES |
Iowa | MEDICAID | 0274506 | |
Iowa | MEDICAID | 34312600 |
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