Provider Demographics
NPI:1447241138
Name:TIVNON, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:TIVNON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 OLD RIVER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9503
Mailing Address - Country:US
Mailing Address - Phone:661-663-7600
Mailing Address - Fax:661-663-7676
Practice Address - Street 1:300 OLD RIVER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9503
Practice Address - Country:US
Practice Address - Phone:661-663-7600
Practice Address - Fax:661-663-7676
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA24851207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24160Medicare UPIN