Basic Information
| Provider Information | |||||||||
| NPI: | 1497329460 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANESTHESIA4U, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROSTISLAV PAVLIK | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29650 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850389650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552019056 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1610 DRY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805036405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037721600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2021 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | PAVLIK | ||||||||
| AuthorizedOfficialFirstName: | ROSTISLAV | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8552019056 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.