Provider Demographics
NPI:1134127327
Name:RADIC, ZELJKO S (MD)
Entity Type:Individual
Prefix:DR
First Name:ZELJKO
Middle Name:S
Last Name:RADIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:4550 WILLS RD
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-0034
Mailing Address - Country:US
Mailing Address - Phone:615-654-3383
Mailing Address - Fax:615-654-3383
Practice Address - Street 1:4550 WILLS RD
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049-0034
Practice Address - Country:US
Practice Address - Phone:615-654-3383
Practice Address - Fax:615-654-3383
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01052796207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN163856OtherCSHCS
IN163857OtherCSHCS
IN200357590Medicaid
INP00199426OtherRAILROAD MEDICARE
IN163855OtherCSHCS
IN200357590Medicaid
IN163855OtherCSHCS