Provider Demographics
NPI:1639110877
Name:CANKOVIC, LANA (MD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:CANKOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ROSELANE STREET NW
Mailing Address - Street 2:SUITE 750
Mailing Address - City:MARIETTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-794-0477
Mailing Address - Fax:770-794-3108
Practice Address - Street 1:51 ROSELANE STREET NW
Practice Address - Street 2:SUITE 750
Practice Address - City:MARIETTTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-794-0477
Practice Address - Fax:770-794-3108
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25350207L00000X
GA055186207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009949135Medicaid
AL051520796OtherBLUE CROSS
AL010033CH72657OtherSECTION 1011
AL051520798OtherBLUE CROSS
AL009947365Medicaid
AL051520797OtherBLUE CROSS
MS07833224OtherMISSISSIPPI MEDICAID
ALP00215395OtherRAILROAD MEDICARE
AL009949125Medicare ID - Type Unspecified
AL009947365Medicaid