Provider Demographics
NPI:1063474500
Name:HLIVKO, THOMAS
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:HLIVKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E WATERLOO RD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:2215 E WATERLOO RD
Practice Address - Street 2:STE 313
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3856
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044189207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000130951OtherANTHEM BLUE CROSS BLUE SHIELD
OH0198754Medicaid
000000191217OtherUNISON HEALTH NETWORK
000000130951OtherANTHEM BLUE CROSS BLUE SHIELD
220024036Medicare PIN
000000191217OtherUNISON HEALTH NETWORK