Individual
DR. JUDITH ANN IVACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-3325
(734) 712-5525
Mailing address
PO BOX 446, ANN ARBOR, MI 48106-0446
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
43-01-058648
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4282589
—
MI
Enumeration date
03/23/2006
Last updated
10/14/2016
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