| David G Provaznik Do Inc | |
|
11826 Gallia Pike Rd Suite A Wheelersburg OH 45694-9119 | |
| (740) 574-4526 | |
| (740) 574-2895 |
| Full Name | David G Provaznik Do Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 11826 Gallia Pike Rd, Wheelersburg, Ohio |
| Authorized Official Name and Position | David Gerard Provaznik (PRESIDENT/CEO) |
| Authorized Official Contact | 7405744526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David G Provaznik Do Inc 11826 Gallia Pike Rd Suite A Wheelersburg OH 45694-9119 Ph: (740) 574-4526 | David G Provaznik Do Inc 11826 Gallia Pike Rd Suite A Wheelersburg OH 45694-9119 Ph: (740) 574-4526 |
| NPI Number | 1780799775 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 05/18/2010 |
| Medicare PECOS PAC ID | 3971536244 |
|---|---|
| Medicare Enrollment ID | O20050916000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780799775 | NPI | - | NPPES |
| 0965915 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34005337 (Ohio) | Primary |
| Provider Name | David Provaznik |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245267624 PECOS PAC ID: 8729080684 Enrollment ID: I20091230000638 |
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