Provider Demographics
NPI:1174791636
Name:KIRVAITIS, ROMAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ROMAS
Middle Name:JOSEPH
Last Name:KIRVAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 SOUTH DOBSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6105
Mailing Address - Country:US
Mailing Address - Phone:480-814-0266
Mailing Address - Fax:480-814-0018
Practice Address - Street 1:803 N SALK DR
Practice Address - Street 2:BUILDING A
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5447
Practice Address - Country:US
Practice Address - Phone:480-814-0266
Practice Address - Fax:480-814-0018
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ33802207RC0000X
AZ33082207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ544434Medicaid
AZG57789Medicare UPIN
AZZ162019Medicare PIN