Provider Demographics
NPI:1700053923
Name:ZIVKO Z. GAJIC M.D., P.A.
Entity Type:Organization
Organization Name:ZIVKO Z. GAJIC M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIVKO
Authorized Official - Middle Name:Z
Authorized Official - Last Name:GAJIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-735-4177
Mailing Address - Street 1:2505 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3934
Mailing Address - Country:US
Mailing Address - Phone:305-735-4177
Mailing Address - Fax:305-295-8404
Practice Address - Street 1:2505 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3934
Practice Address - Country:US
Practice Address - Phone:305-735-4177
Practice Address - Fax:305-295-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96002OtherBCBS
FL069563700Medicaid
FL96002OtherBCBS
FLB45307Medicare UPIN