Provider Demographics
NPI:1821003393
Name:MLADINICH, ERNEST KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:KENNETH
Last Name:MLADINICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E
Other - Middle Name:KENNETH
Other - Last Name:MLADINICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8120 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7654
Mailing Address - Country:US
Mailing Address - Phone:505-291-2730
Mailing Address - Fax:505-291-2790
Practice Address - Street 1:8120 CONSTITUTION PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7654
Practice Address - Country:US
Practice Address - Phone:505-291-2730
Practice Address - Fax:505-291-2790
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75-2142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology