Provider Demographics
NPI:1255494233
Name:STEVANOVIC, NEBOJSA (MD)
Entity Type:Individual
Prefix:
First Name:NEBOJSA
Middle Name:
Last Name:STEVANOVIC
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 1:11111 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4033
Mailing Address - Country:US
Mailing Address - Phone:414-546-8000
Mailing Address - Fax:414-546-2909
Practice Address - Street 1:11111 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-4033
Practice Address - Country:US
Practice Address - Phone:414-546-8000
Practice Address - Fax:414-546-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE-21104Medicare UPIN