Individual
IVAN PIVOVAROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
279 HUGHES RD, MADISON, AL 35758-1142
(256) 289-1733
Mailing address
279 HUGHES RD, MADISON, AL 35758-1142
(256) 325-0480
(256) 325-0481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29030
AL
Other
Enumeration date
05/23/2007
Last updated
07/21/2022
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