Provider Demographics
NPI:1225011836
Name:ZIVIC, MIODRAG (MD)
Entity Type:Individual
Prefix:DR
First Name:MIODRAG
Middle Name:
Last Name:ZIVIC
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 1:99 NORTHLINE CIR STE 215
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1481
Mailing Address - Country:US
Mailing Address - Phone:216-383-2834
Mailing Address - Fax:216-383-2923
Practice Address - Street 1:99 NORTHLINE CIR STE 215
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1481
Practice Address - Country:US
Practice Address - Phone:216-383-2834
Practice Address - Fax:216-383-2923
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2590003Medicaid
OHI28879Medicare UPIN
OH2590003Medicaid