Provider Demographics
NPI:1679869572
Name:KIVLIN, DANA UFNAL (DO)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:UFNAL
Last Name:KIVLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SAYBROOK RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4700
Mailing Address - Country:US
Mailing Address - Phone:860-347-8850
Mailing Address - Fax:
Practice Address - Street 1:520 SAYBROOK RD STE 100B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-347-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT559272088F0040X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008076307Medicaid