Organization
EUGENE VITVITSKY MD
Active
Other names
Havasu Vein Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE VITVITSKY M.D. (CO-OWNER)
(928) 855-4411
Entity
Organization
Contact information
Practice address
2046 BURKE LANE, LAKE HAVASU CITY, AZ 86406
(928) 855-4411
(928) 855-4418
Mailing address
1845 MCCOLLOCH BLVD, SUITE A-2, LAKE HAVASU CITY, AZ 86403
(928) 855-4411
(928) 855-4418
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
35142
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0440881
BLUE CROSS OF ARIZONA
AZ
Enumeration date
04/16/2007
Last updated
08/22/2020
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