1134205735 NPI number — MIO M STIKOVAC M.D.

Table of content: MIO M STIKOVAC M.D. (NPI 1134205735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134205735 NPI number — MIO M STIKOVAC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIKOVAC
Provider First Name:
MIO
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STIKOVAC
Provider Other First Name:
MIODRAG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134205735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 LAS VEGAS BLVD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NELLIS AFB
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-653-3257
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 LAS VEGAS BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NELLIS AFB
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-653-3257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

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: 207RC0000X , with the licence number:  01049387A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 30015 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200059360 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3121962 . This is a "BCBS TENNESSEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060057636 . This is a "RAILROAD MEDICARE/MADISON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 159683 . This is a "SIHO-CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 415633P . This is a "SIHO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1169908 . This is a "CHA PROVIDER NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 835778 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01333108 . This is a "MEDICARE RR-CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000867525 . This is a "ANTHEM-CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 299856 . This is a "FEDERAL BLACK LUNG PROGRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50065353 . This is a "PASSPORT-CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 060052920 . This is a "RAILROAD MEDICARE TVILLE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2552053001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000052136 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1079152 . This is a "PASSPORT HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25-00439 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64300155 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060052923 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6113371060A11 . This is a "ANTHEM SR. ADVANTAGE" identifier . This identifiers is of the category "OTHER".




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