Provider Demographics
NPI:1457336562
Name:URBANCIC, JOHN MILAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MILAN
Last Name:URBANCIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13221 RAVENNA RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9047
Mailing Address - Country:US
Mailing Address - Phone:440-286-6155
Mailing Address - Fax:440-286-6156
Practice Address - Street 1:13221 RAVENNA RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9047
Practice Address - Country:US
Practice Address - Phone:440-286-6155
Practice Address - Fax:440-286-6156
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2020-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35071426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080126984OtherRAILROAD MEDICARE
OH2074231Medicaid
OHG73612Medicare UPIN
OH080126984OtherRAILROAD MEDICARE