Provider Demographics
NPI:1932524113
Name:ZIVKOVIC FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:ZIVKOVIC FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIVKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-772-7202
Mailing Address - Street 1:949 CHIQUITA BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2143
Mailing Address - Country:US
Mailing Address - Phone:239-772-7202
Mailing Address - Fax:239-424-0457
Practice Address - Street 1:949 CHIQUITA BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2143
Practice Address - Country:US
Practice Address - Phone:239-772-7202
Practice Address - Fax:239-424-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI06010Medicare UPIN
FLHT694AMedicare PIN