Provider Demographics
NPI:1083259873
Name:POPOVIC MEDICAL INC
Entity Type:Organization
Organization Name:POPOVIC MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-429-4487
Mailing Address - Street 1:2081 FOREST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4841
Mailing Address - Country:US
Mailing Address - Phone:669-249-9459
Mailing Address - Fax:408-294-1753
Practice Address - Street 1:2081 FOREST AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4841
Practice Address - Country:US
Practice Address - Phone:669-249-9459
Practice Address - Fax:408-294-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96234OtherLISCENSE