Provider Demographics
NPI:1295045433
Name:OLIVER A. CVITANIC MD, PC
Entity Type:Organization
Organization Name:OLIVER A. CVITANIC MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CVITANIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-634-8405
Mailing Address - Street 1:PO BOX 12746
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2746
Mailing Address - Country:US
Mailing Address - Phone:405-607-1325
Mailing Address - Fax:405-607-1326
Practice Address - Street 1:230 SW 80TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8107
Practice Address - Country:US
Practice Address - Phone:405-634-8405
Practice Address - Fax:405-634-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK165872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05111Medicare UPIN