Provider Demographics
NPI:1396878203
Name:OVACIK, MUSTAFA E (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:E
Last Name:OVACIK
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:P.O. BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:765-448-8085
Practice Address - Street 1:2995 NORTH SALISBURY STREET
Practice Address - Street 2:
Practice Address - City:W. LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1435
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7606
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4031031286208000000X
IN01065311A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200897230Medicaid
IN000000597245OtherANTHEM PROVIDER NUMBER
IN200897230Medicaid
INF21133Medicare UPIN