Provider Demographics
NPI:1972777381
Name:TODIC, VLADO
Entity Type:Individual
Prefix:MR
First Name:VLADO
Middle Name:
Last Name:TODIC
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VLADO
Other - Middle Name:
Other - Last Name:TODIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27117 N 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-6314
Mailing Address - Country:US
Mailing Address - Phone:602-469-2149
Mailing Address - Fax:623-434-4277
Practice Address - Street 1:27117 N 52ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-6314
Practice Address - Country:US
Practice Address - Phone:602-469-2149
Practice Address - Fax:623-434-4277
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ314418343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)