Provider Demographics
NPI:1891762969
Name:MILUTIN, SLAVENKA (MD)
Entity Type:Individual
Prefix:
First Name:SLAVENKA
Middle Name:
Last Name:MILUTIN
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 1:340 WOOD ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-794-2300
Mailing Address - Fax:781-794-2215
Practice Address - Street 1:340 WOOD ROAD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-794-2300
Practice Address - Fax:781-794-2215
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA464202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E05342OtherBCBS MA
A54718Medicare UPIN
E05342Medicare ID - Type Unspecified