Active NPI
Ian Martin Shivack, M.D.
- Psychiatry Physician
- Tucson, AZ
National Provider Identifier
1891139994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 24360
- Practice address
- 4250 N Camino Arco
Tucson, AZ 85718-7015 - Phone
- (520) 529-3940
- Fax
- (520) 529-3940
- NPI assigned
- Apr 19, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 24360 | AZ | Primary |
Addresses
Primary practice location
4250 N Camino Arco
Tucson, AZ 85718-7015
Mailing address
4250 N Camino Arco
Tucson, AZ 85718-7015
Phone (520) 529-3940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24360 | AZ | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1891139994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4250 N CAMINO ARCO",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857187015",
"telephone_number": "520-529-3940",
"fax_number": "520-529-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4250 N CAMINO ARCO",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857187015",
"telephone_number": "520-529-3940",
"fax_number": "520-529-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIVACK",
"first_name": "IAN",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-19",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "24360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.