Provider Demographics
NPI:1043298276
Name:PYEVICH, MICHAEL T (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:PYEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 53RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7564
Mailing Address - Country:US
Mailing Address - Phone:563-322-0971
Mailing Address - Fax:563-324-0615
Practice Address - Street 1:2300 53RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7564
Practice Address - Country:US
Practice Address - Phone:563-322-0971
Practice Address - Fax:563-324-0615
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33070207X00000X
IL036100798207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190439Medicaid
16151OtherMIDLANDS CHOICE
143481OtherIA HEALTH SOLUTIONS
IL8121085OtherBCBS
IL96772OtherWELLMARK
IAIA0137OtherJOHN DEERE FAMILY
IA01648OtherWELLMARK
IA200036823OtherRR MEDICARE
048933OtherHEALTH ALLIANCE
IL200043836OtherRR MEDICARE
ILIL0138OtherJOHN DEERE FAMILY
IL91389OtherWELLMARK
IAIA0148OtherJOHN DEERE FAMILY
IL036100798Medicaid
IL96772OtherWELLMARK
143481OtherIA HEALTH SOLUTIONS
IL036100798Medicaid