1477537314 NPI number — MILA DAVIDOVIC DPM

Table of content: MILA DAVIDOVIC DPM (NPI 1477537314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477537314 NPI number — MILA DAVIDOVIC DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIDOVIC
Provider First Name:
MILA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477537314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6115 POWERS BLVD
Provider Second Line Business Mailing Address:
STE 305
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44129-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-743-2525
Provider Business Mailing Address Fax Number:
440-743-2526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6115 POWERS BLVD
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44129-5469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-743-2525
Provider Business Practice Location Address Fax Number:
440-743-2526
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36002588 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34167855900 . This is a "BUREAU OF WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4211887 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0805383 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1423902 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2780540 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480011633 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000136489 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700182 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341678559026 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".




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