Provider Demographics
NPI:1740217397
Name:IVANHOE, CINDY (MD)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:IVANHOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 MOURSUND ST
Mailing Address - Street 2:#D110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3405
Mailing Address - Country:US
Mailing Address - Phone:713-797-5236
Mailing Address - Fax:713-797-5241
Practice Address - Street 1:1333 MOURSUND ST
Practice Address - Street 2:#D110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-797-5236
Practice Address - Fax:713-797-5241
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2616208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F0862Medicare ID - Type Unspecified
TXP00871440Medicare PIN
TXTXB102212Medicare PIN
J2616Medicare UPIN