# IVANKA A. VASSILEVA, M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245428630
- **Authorized official:** MS. IVANKA A. VASSILEVA M.D. (OWNER)
- **Authorized official phone:** (580) 354-9600

## Contact information

- **Practice address:** 4411 W GORE BLVD, SUITE B-10, LAWTON, OK 73505-5977
- **Practice address phone:** (580) 354-9600
- **Practice address fax:** (580) 354-9621
- **Mailing address:** 4411 W GORE BLVD, SUITE B-10, LAWTON, OK 73505-5977
- **Mailing address phone:** (580) 354-9600
- **Mailing address fax:** (580) 354-9621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 22970 | OK | Yes |

## Other

- **Enumeration date:** 10/10/2007
- **Last updated:** 02/09/2012