Provider Demographics
NPI:1720154172
Name:GAJIC, ZIVKO Z (MD)
Entity Type:Individual
Prefix:
First Name:ZIVKO
Middle Name:Z
Last Name:GAJIC
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 1:2505 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3934
Mailing Address - Country:US
Mailing Address - Phone:305-295-6790
Mailing Address - Fax:305-295-8404
Practice Address - Street 1:2505 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3934
Practice Address - Country:US
Practice Address - Phone:305-295-6790
Practice Address - Fax:305-295-8404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39762207P00000X
FLME39762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069563700Medicaid
FL96002OtherBCBS
B45307Medicare UPIN
FL96002OtherBCBS