Provider Demographics
NPI:1619920089
Name:BEKAVAC, IVO (MD PHD)
Entity Type:Individual
Prefix:
First Name:IVO
Middle Name:
Last Name:BEKAVAC
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5954
Mailing Address - Fax:319-833-5955
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 112
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-833-5954
Practice Address - Fax:319-833-5955
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA325522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA421417307B9OtherJOHN DEERE HEALTH INS PLA
IA0177550Medicaid
IA45896OtherWELLMARK INS PLAN
IA0177550Medicaid
IA421417307B9OtherJOHN DEERE HEALTH INS PLA