Provider Demographics
NPI:1245612233
Name:ALEKSANDAR ROSICH MD INC
Entity Type:Organization
Organization Name:ALEKSANDAR ROSICH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-427-7820
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-0934
Mailing Address - Country:US
Mailing Address - Phone:414-427-7820
Mailing Address - Fax:414-427-3897
Practice Address - Street 1:10105 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-6152
Practice Address - Country:US
Practice Address - Phone:414-427-7820
Practice Address - Fax:414-427-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34064700Medicaid