Provider Demographics
NPI:1609809078
Name:UJEVICH, MILO MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MILO
Middle Name:MARK
Last Name:UJEVICH
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 1:839 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-1170
Mailing Address - Country:US
Mailing Address - Phone:724-695-7629
Mailing Address - Fax:
Practice Address - Street 1:839 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-1170
Practice Address - Country:US
Practice Address - Phone:724-695-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048446L2085R0202X
FLME 963072085R0202X
OH35. 0592182085R0202X
WV159322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01275203Medicaid
OH0764918Medicaid
PA059130Medicare ID - Type Unspecified
OH0764918Medicaid
PA01275203Medicaid
OH4189403Medicare PIN