Provider Demographics
NPI:1922875103
Name:MATIC, MILAN
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:
Last Name:MATIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 VICEROY ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8518
Mailing Address - Country:US
Mailing Address - Phone:440-289-0125
Mailing Address - Fax:
Practice Address - Street 1:11470 VICEROY ST
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077-8518
Practice Address - Country:US
Practice Address - Phone:440-289-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty