Samuil Ivanovsky
General Practice in Little Rock, AR. Individual provider (NPI-1).
NPI number1417698317
StatusActive
Last updated in NPPESAug 7, 2026
Details
- NPI
- 1417698317
- Entity type
- Individual (NPI-1)
- Name
- Samuil Ivanovsky
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 5, 2022
- Certification date
- Aug 7, 2026
- Last updated
- Aug 7, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | E-19099 | AR | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
4301 W Markham St # 634Little Rock, AR 72205-7199
Phone 501-686-7592
Mailing address
4301 W Markham St # 634Little Rock, AR 72205-7199
Phone 501-686-7592
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