Provider Demographics
NPI:1245499110
Name:MLADINEO, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MLADINEO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4665
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-4665
Mailing Address - Country:US
Mailing Address - Phone:601-981-0707
Mailing Address - Fax:601-362-3070
Practice Address - Street 1:210 RIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4111
Practice Address - Country:US
Practice Address - Phone:601-981-0707
Practice Address - Fax:601-362-3070
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS06945207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB66087Medicare UPIN