Provider Demographics
NPI:1912361585
Name:IVASHCHUK, HALYNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HALYNA
Middle Name:
Last Name:IVASHCHUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST STE MSB 5111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6325
Mailing Address - Fax:713-500-0706
Practice Address - Street 1:6431 FANNIN ST STE MSB 5111
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6325
Practice Address - Fax:713-500-0706
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66182207R00000X
TXS2350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH08LN79901OtherBCBS
TX401715401Medicaid