Provider Demographics
NPI:1508830076
Name:STEVANOVIC CLINICS SC
Entity Type:Organization
Organization Name:STEVANOVIC CLINICS SC
Other - Org Name:STEVANOVIC FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NEBOJSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-546-8000
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39372261QP2300X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32398100Medicaid
WI000001299OtherPTAN
WIE2104Medicare UPIN