Provider Demographics
NPI:1952632440
Name:MILAN P. KRICKOVIC, M.D., LTD.
Entity Type:Organization
Organization Name:MILAN P. KRICKOVIC, M.D., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:PIERSOL
Authorized Official - Last Name:KRICKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-288-8313
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-288-8313
Mailing Address - Fax:804-287-4365
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-288-8313
Practice Address - Fax:804-287-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4390080OtherAETNA
VA0510927OtherAETNA HMO
VA6081070Medicaid
VAB08528Medicare UPIN