Provider Demographics
NPI:1235528720
Name:RISTICH, VLADIMIR (PA-C)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:RISTICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0002
Mailing Address - Country:US
Mailing Address - Phone:800-233-2273
Mailing Address - Fax:
Practice Address - Street 1:6494 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-3145
Practice Address - Country:US
Practice Address - Phone:702-704-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1592363A00000X
CAPA60613363A00000X
OH50.007899363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA60613OtherCALIFORNIA STATE BOARD
NV1235528720Medicaid
NVPA1592OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS