Provider Demographics
NPI:1831173822
Name:MILOSAVLJEVIC, DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:MILOSAVLJEVIC
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 1:225 S EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4257
Mailing Address - Country:US
Mailing Address - Phone:262-787-4050
Mailing Address - Fax:
Practice Address - Street 1:8153 S 27TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9549
Practice Address - Country:US
Practice Address - Phone:414-761-1802
Practice Address - Fax:414-301-9101
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32597-020207L00000X
WI32597208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32159800Medicaid
P00264217OtherRAIL ROAD MEDICARE
WIG13059Medicare UPIN
P00264217OtherRAIL ROAD MEDICARE
WI0039-52590Medicare ID - Type UnspecifiedPROVIDER NUMBER