Provider Demographics
NPI:1801216106
Name:SPIVAK, ANNA (DO)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SPIVAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 E 100TH STREET A30
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-7330
Mailing Address - Fax:216-445-8627
Practice Address - Street 1:9500 E 100 ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3431
Practice Address - Country:US
Practice Address - Phone:216-445-7330
Practice Address - Fax:216-445-8627
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.015433208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery