Provider Demographics
NPI:1376748087
Name:LASKOVSKI, JOVAN RISTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOVAN
Middle Name:RISTE
Last Name:LASKOVSKI
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 1:1622 E. TURKEYFOOT LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5277
Mailing Address - Country:US
Mailing Address - Phone:330-664-7436
Mailing Address - Fax:
Practice Address - Street 1:1622 E TURKEYFOOT LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5277
Practice Address - Country:US
Practice Address - Phone:330-664-7436
Practice Address - Fax:330-664-0167
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093913207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066613Medicaid
OH0066613Medicaid