Provider Demographics
NPI:1467442921
Name:VIDIC, NINO ANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:NINO
Middle Name:ANTON
Last Name:VIDIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:4907B KEYSTONE XING
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-5144
Practice Address - Country:US
Practice Address - Phone:715-514-1585
Practice Address - Fax:715-514-1652
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI502812084P0804X
NE217482084P0804X
NMMD2005-06442084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry