Provider Demographics
NPI:1609839257
Name:DJURASOVIC, MLADEN (MD)
Entity Type:Individual
Prefix:
First Name:MLADEN
Middle Name:
Last Name:DJURASOVIC
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-584-6851
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36490207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200327760Medicaid
KY36123OtherCIGNA (SPINE INSTITUTE)
KY000000212609OtherANTHEM (UNIVERSITY ORTHOP
KY00533159OtherMEDICARE KENTUCKY- NORTON LEATHERMAN SPINE CENTER
KY2481222OtherCIGNA- NORTON LEATHERMAN SPINE CENTER
INN302052OtherHARMONY (SPINE INSTITUTE)
KYP00757244OtherRAILROAD MEDICARE- NORTON LEATHERMAN SPINE CENTER
KY2438480000OtherPASSPORT ADVANTAGE (SPINE
KY2438491000OtherPASSPORT ADVANTAGE (UNIVE
KY3728036000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY000000212608OtherANTHEM (SPINE INSTITUTE)
KY64036908Medicaid
KY1148797OtherPASSPORT (SPINE INSTITUTE
KY1149201OtherPASSPORT (UNIVERSITY ORTH
KY163722400OtherUS DEPT OF LABOR
KYP00071772OtherRAILROAD MEDICARE (SPINE
KY000028412YOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY0942470001OtherDMERC (SPINE INSTITUTE)
KY50024960OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
KY000000628570OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY017207OtherSIHO- NORTON LEATHERMAN SPINE CENTER
KY0235827Medicare PIN
IN196290NNNNMedicare PIN
KY2438491000OtherPASSPORT ADVANTAGE (UNIVE
KY64036908Medicaid
IN141460GMedicare PIN