Provider Demographics
NPI:1205918422
Name:PAVKOVIC, STEVEN ANTHONY (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANTHONY
Last Name:PAVKOVIC
Suffix:
Gender:M
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:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-1449
Mailing Address - Country:US
Mailing Address - Phone:714-996-1633
Mailing Address - Fax:714-996-9267
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-460-1796
Practice Address - Fax:714-996-9267
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74968207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G749680Medicaid
CA00G749680OtherBLUE SHIELD
GA440002887OtherRAILROAD RETIREMENT
CA00G749680Medicaid
CAG74968Medicare ID - Type Unspecified