Provider Demographics
NPI:1659330199
Name:PREDANIC, MLADEN (MD MSC)
Entity Type:Individual
Prefix:
First Name:MLADEN
Middle Name:
Last Name:PREDANIC
Suffix:
Gender:M
Credentials:MD MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 LBJ FWY STE 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1912
Mailing Address - Country:US
Mailing Address - Phone:972-792-5700
Mailing Address - Fax:
Practice Address - Street 1:2460 N INTERSTATE HIGHWAY 35 E STE 165
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:214-506-2617
Practice Address - Fax:972-788-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218183207V00000X, 207VM0101X
TXN4680207V00000X, 207VX0000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196358Medicaid
NY0105NGMedicare ID - Type Unspecified
H51436Medicare UPIN