Provider Demographics
NPI:1598742744
Name:IVAN, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:IVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-379-8190
Mailing Address - Fax:330-379-8191
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-8190
Practice Address - Fax:330-379-8191
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-0639762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2247956Medicaid
OH2247956Medicaid
F 53722Medicare UPIN