Provider Demographics
NPI:1578738936
Name:ROBERT J SIVAK, M.D., LTD
Entity Type:Organization
Organization Name:ROBERT J SIVAK, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-345-1200
Mailing Address - Street 1:4600 S MILL AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6758
Mailing Address - Country:US
Mailing Address - Phone:480-345-1200
Mailing Address - Fax:480-345-1281
Practice Address - Street 1:4600 S MILL AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6757
Practice Address - Country:US
Practice Address - Phone:480-345-1200
Practice Address - Fax:480-345-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty