Basic Information
| Provider Information | |||||||||
| NPI: | 1295045433 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OLIVER A. CVITANIC MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12746 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731572746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056071325 | ||||||||
| FaxNumber: | 4056071326 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 SW 80TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731398107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056348405 | ||||||||
| FaxNumber: | 4056348709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| AuthorizedOfficialLastName: | CVITANIC | ||||||||
| AuthorizedOfficialFirstName: | OLIVER | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4056348405 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 16587 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.