Ivanitsky, Michael Mstislavovich

Ivanitsky, Michael Mstislavovich is an individual health care provider with primary practice located at 940 E 5Th St , Coquille OR 97423-1699. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Ivanitsky, Michael Mstislavovich can be contacted via phone (541) 396-3111.

Contact Information

Primary practice address
940 E 5Th St Coquille OR 97423-1699
Phone: (541) 396-3111
Fax: (541) 396-8135
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X MD22589 Oregon

Profile Details

NPI number 1003837410
LBN Legal business name Ivanitsky, Michael Mstislavovich
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Sep 4th, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003837410 NPPES
Oregon MEDICAID 288121

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