Individual
DR. MICHAEL R SIVULICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
93 CAMPUS AVE, LEWISTON, ME 04240-6030
(207) 755-3636
(207) 755-3652
Mailing address
PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8553
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
11922
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002390
ANTHEM
—
01
—
100005851
RAILROAD MEDICARE
—
01
—
1040131
AETNA
—
05
—
309480099
—
ME
Enumeration date
12/15/2005
Last updated
12/30/2014
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