Provider Demographics
NPI:1902843899
Name:SIVAK, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SIVAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 MISSION POINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-6600
Mailing Address - Country:US
Mailing Address - Phone:937-912-4441
Mailing Address - Fax:937-429-4236
Practice Address - Street 1:1305 BOARDMAN POLAND RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1935
Practice Address - Country:US
Practice Address - Phone:330-629-2300
Practice Address - Fax:330-629-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004606S207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0714794Medicaid
OH942460636209OtherCARESOURCE
OHP00220368OtherMEDICARE RR-GA
OHP00220368OtherMEDICARE RR-GA
OHSI4068435Medicare ID - Type Unspecified