Provider Demographics
NPI:1114955614
Name:SPAHIJA, MIRJANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIRJANA
Middle Name:
Last Name:SPAHIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16687 ST CLAIR AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43928
Mailing Address - Country:US
Mailing Address - Phone:330-382-1070
Mailing Address - Fax:330-382-0916
Practice Address - Street 1:16687 ST CLAIR AVE
Practice Address - Street 2:STE 201
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43928
Practice Address - Country:US
Practice Address - Phone:330-382-1070
Practice Address - Fax:330-382-0916
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3580889208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
32001592000OtherOH COMP
7780368OtherAETNA
OH2324274Medicaid
OH2745739Medicaid
1808339000OtherWV WELFARE
OH2745739Medicaid
32001592000OtherOH COMP
OH4082651Medicare ID - Type Unspecified