Provider Demographics
NPI:1669587960
Name:SLAVICH, IVAN LEWIS III (DO)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:LEWIS
Last Name:SLAVICH
Suffix:III
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 1:2375 CHAMPIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-321-3809
Mailing Address - Fax:334-321-3798
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-321-3809
Practice Address - Fax:334-321-3798
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO222207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911606Medicaid
AL009911614Medicaid
AL009911616Medicaid
AL009911618Medicaid
AL009911604Medicaid
AL051542107OtherBCBS PROVIDER NUMBER
AL051542108OtherBCBS PROVIDER NUMBER
AL009911607Medicaid
AL009911621Medicaid
AL051542105OtherBCBS PROVIDER NUMBER
AL051542109OtherBCBS PROVIDER NUMBER
AL009911613Medicaid
AL009911619Medicaid
AL009911622Medicaid
AL051542103OtherBCBS PROVIDER NUMBER
AL051542110OtherBCBS PROVIDER NUMBER
AL1669587960OtherNPI
AL009911617Medicaid
AL051542107OtherBCBS PROVIDER NUMBER
AL009911607Medicaid