Provider Demographics
NPI:1093776254
Name:CUTURIC, MIROSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:
Last Name:CUTURIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-293-7330
Practice Address - Street 1:8 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 420
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-565-6050
Practice Address - Fax:803-565-6051
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC197662084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG654149482OtherMEDICARE PTAN
SCGP5417OtherMEDICAID GROUP
SC197664Medicaid
G654144411Medicare ID - Type Unspecified
SC197664Medicaid
SCGP5417OtherMEDICAID GROUP
SCG654144411Medicare PIN