Individual
JOHN G IVANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10505 E 91ST ST, SUITE 208, TULSA, OK 74133-5801
(918) 494-8500
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3347
(918) 488-6001
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
19125
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100023590A
—
OK
01
—
300522262
MEDICARE GROUP PIN
OK
Enumeration date
01/26/2006
Last updated
06/13/2019
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