Provider Demographics
NPI:1881690766
Name:SHIVITZ, IRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:A
Last Name:SHIVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-320-7200
Mailing Address - Fax:615-320-7203
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-320-7200
Practice Address - Fax:615-320-7203
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15763174400000X
TNMD15763207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00001364OtherNHC HEALTH BENEFIT PLAN
TN3126360OtherTENNCARE SELECT
TN621745543000OtherPRUDENTIAL
TN621745543OtherHUMANA
TNB58858OtherHEALTHSPRING
TN2150030OtherAETNA
TN3126360OtherACCORDIA OF LEXINGTON
TN3126360OtherBCBS
TN0627781OtherCIGNA
TN0840173OtherUNITED HEALTHCARE
TN180036789OtherRAIL ROAD MEDICARE
TN3717165Medicaid
TN180036789OtherRAIL ROAD MEDICARE