Individual
DR. IVAN FOMITCHEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8711 WALES RESERVE, SAN ANTONIO, TX 78255-3371
(563) 564-1283
Mailing address
8711 WALES RESERVE, SAN ANTONIO, TX 78255-3371
(563) 564-1283
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34875
IA
208VP0000X
Pain Medicine Physician
34875
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0274506
—
IA
05
—
34312600
—
WI
Enumeration date
03/01/2006
Last updated
05/19/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us