Provider Demographics
NPI:1417207283
Name:PIVIK, KARLA S (DO)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:S
Last Name:PIVIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:P
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2450 NE MARY ROSE PL STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7133
Mailing Address - Country:US
Mailing Address - Phone:541-585-7546
Mailing Address - Fax:541-582-7177
Practice Address - Street 1:2239 NE DOCTORS DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7185
Practice Address - Country:US
Practice Address - Phone:541-585-7546
Practice Address - Fax:541-582-7177
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010201672085R0202X
ORDO164262207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology