Provider Demographics
NPI:1134205735
Name:STIKOVAC, MIO M (MD)
Entity type:Individual
Prefix:
First Name:MIO
Middle Name:M
Last Name:STIKOVAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIODRAG
Other - Middle Name:
Other - Last Name:STIKOVAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:NELLIS AFB
Mailing Address - State:NV
Mailing Address - Zip Code:89191
Mailing Address - Country:US
Mailing Address - Phone:702-653-3257
Mailing Address - Fax:
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:NELLIS AFB
Practice Address - State:NV
Practice Address - Zip Code:89191
Practice Address - Country:US
Practice Address - Phone:702-653-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049387A207RC0000X
KY30015207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200059360Medicaid
3121962OtherBCBS TENNESSEE
IN060057636OtherRAILROAD MEDICARE/MADISON
KY159683OtherSIHO-CTS
IN415633POtherSIHO
1169908OtherCHA PROVIDER NETWORK
835778OtherFIRST HEALTH
KYP01333108OtherMEDICARE RR-CTS
KY000000867525OtherANTHEM-CTS
299856OtherFEDERAL BLACK LUNG PROGRA
KY50065353OtherPASSPORT-CTS
060052920OtherRAILROAD MEDICARE TVILLE
2552053001OtherCIGNA
KY000000052136OtherANTHEM BCBS
1079152OtherPASSPORT HEALTH PLAN
KY25-00439OtherUNITED HEALTHCARE
KY64300155Medicaid
KY060052923OtherRAILROAD MEDICARE
6113371060A11OtherANTHEM SR. ADVANTAGE
KY000000867525OtherANTHEM-CTS
IN415633POtherSIHO
KY00181005Medicare ID - Type UnspecifiedCARROLLTON
IN200059360Medicaid
IN060057636OtherRAILROAD MEDICARE/MADISON
KY0875302Medicare ID - Type UnspecifiedTOMPKINSVILLE
KY159683OtherSIHO-CTS