Provider Demographics
NPI:1326244609
Name:JOSEPH J. SIVAK, MD, PLLC
Entity Type:Organization
Organization Name:JOSEPH J. SIVAK, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-740-3061
Mailing Address - Street 1:324 W SUPERIOR ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-740-3061
Mailing Address - Fax:218-740-3044
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:SUITE 505
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-740-3061
Practice Address - Fax:218-740-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN434502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03914Medicare ID - Type UnspecifiedMEDICARE GROUP #