| Ivanka A. Vassileva, M.d., P.c. | |
|
4411 W Gore Blvd Suite B-10 Lawton OK 73505-5977 | |
| (580) 354-9600 | |
| (580) 354-9621 |
| Full Name | Ivanka A. Vassileva, M.d., P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4411 W Gore Blvd, Lawton, Oklahoma |
| Authorized Official Name and Position | Ivanka A. Vassileva (OWNER) |
| Authorized Official Contact | 5803549600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivanka A. Vassileva, M.d., P.c. 4411 W Gore Blvd Suite B-10 Lawton OK 73505-5977 Ph: (580) 354-9600 | Ivanka A. Vassileva, M.d., P.c. 4411 W Gore Blvd Suite B-10 Lawton OK 73505-5977 Ph: (580) 354-9600 |
| NPI Number | 1245428630 |
|---|---|
| Provider Enumeration Date | 10/10/2007 |
| Last Update Date | 02/09/2012 |
| Medicare PECOS PAC ID | 8527097013 |
|---|---|
| Medicare Enrollment ID | O20050804000956 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245428630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 22970 (Oklahoma) | Primary |
| Provider Name | Ivanka A Vassileva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295729929 PECOS PAC ID: 5092757393 Enrollment ID: I20050811000342 |
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