Fomitchev, Ivan

Fomitchev, Ivan is an individual health care provider with primary practice located at 8711 Wales Reserve , San Antonio TX 78255-3371. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Fomitchev, Ivan can be contacted via phone (563) 564-1283.

Contact Information

Primary practice address
8711 Wales Reserve San Antonio TX 78255-3371
Phone: (563) 564-1283
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 208VP0000X 34875 Iowa
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 34875 Iowa

Profile Details

NPI number 1699742312
LBN Legal business name Fomitchev, Ivan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2006
Last updated May 19th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699742312 NPPES
Iowa MEDICAID 0274506
Iowa MEDICAID 34312600

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