Provider Demographics
NPI:1962476879
Name:TONKOVIC-CAPIN, MISLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:MISLAV
Middle Name:
Last Name:TONKOVIC-CAPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3628
Mailing Address - Country:US
Mailing Address - Phone:414-647-3465
Mailing Address - Fax:414-647-7349
Practice Address - Street 1:3000 W MONTANA ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3628
Practice Address - Country:US
Practice Address - Phone:414-647-3465
Practice Address - Fax:414-647-7349
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35072207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04594396OtherECFMG
WI32003200Medicaid
WI32003200Medicaid
0029H73601Medicare ID - Type Unspecified