Provider Demographics
NPI:1477537314
Name:DAVIDOVIC, MILA (DPM)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:DAVIDOVIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 POWERS BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5469
Mailing Address - Country:US
Mailing Address - Phone:440-743-2525
Mailing Address - Fax:440-743-2526
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5469
Practice Address - Country:US
Practice Address - Phone:440-743-2525
Practice Address - Fax:440-743-2526
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002588213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
34167855900OtherBUREAU OF WORKERS COMP
4211887OtherAETNA
OH0805383Medicaid
1423902OtherUNITED MINE WORKERS
2780540OtherUNITED HEALTH CARE
480011633OtherMEDICARE RR
000000136489OtherANTHEM
2700182OtherPHS
341678559026OtherCARESOURCE
2700182OtherPHS
341678559026OtherCARESOURCE
34167855900OtherBUREAU OF WORKERS COMP
U08699Medicare UPIN
OH0675604Medicare PIN