Provider Demographics
NPI:1265487789
Name:NIKOLIC, AJSA ANA SOFIJA (MD)
Entity Type:Individual
Prefix:DR
First Name:AJSA
Middle Name:ANA SOFIJA
Last Name:NIKOLIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3814
Mailing Address - Country:US
Mailing Address - Phone:504-388-5900
Mailing Address - Fax:504-552-2433
Practice Address - Street 1:900 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130
Practice Address - Country:US
Practice Address - Phone:504-388-5900
Practice Address - Fax:504-552-2433
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26220207Q00000X
NMMD2018-0193207Q00000X
FLME90266207Q00000X
WI69498-20207Q00000X
IL036.139516207Q00000X
NE28930207Q00000X
LA025945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAI21637Medicare UPIN
LA4J230Medicare ID - Type Unspecified