Provider Demographics
NPI:1427022037
Name:IVAN, MIHAELA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIHAELA
Middle Name:C
Last Name:IVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIHAELA
Other - Middle Name:
Other - Last Name:GHEORGHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1977 BUTLER BLVD
Mailing Address - Street 2:E 4.400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-4838
Mailing Address - Fax:713-798-5583
Practice Address - Street 1:3955 PATIENT CARE WAY
Practice Address - Street 2:SUITEA
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:517-374-7603
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN63812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427022037Medicaid
MI1427022037Medicaid
I43324Medicare UPIN