Provider Demographics
NPI:1780792739
Name:NESKOVIC, SPASOJE M (MD)
Entity type:Individual
Prefix:DR
First Name:SPASOJE
Middle Name:M
Last Name:NESKOVIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 E OLIVE AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2132
Mailing Address - Country:US
Mailing Address - Phone:818-244-4114
Mailing Address - Fax:818-861-7434
Practice Address - Street 1:500 E OLIVE AVE STE 750
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501
Practice Address - Country:US
Practice Address - Phone:818-244-4114
Practice Address - Fax:314-536-8705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA044399207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50520Medicare UPIN
CAA44399Medicare PIN