Provider Demographics
NPI:1538124789
Name:TSIVIS, PETER ALLEN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ALLEN
Last Name:TSIVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:ALLEN
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4950 NE 29 AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-481-8405
Mailing Address - Fax:
Practice Address - Street 1:3000 CORAL HILLS DRIVE
Practice Address - Street 2:CORAL SPRINGS MEDICAL CENTER
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-344-3053
Practice Address - Fax:954-346-4226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056657207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B39894Medicare UPIN
FL72637Medicare ID - Type Unspecified