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1134205735

NPI Code Detail

MEDICARE: MIO M STIKOVAC M.D.

MEDICARE: MIO M STIKOVAC M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	01049387A	IN
2	207RC0000X	Cardiovascular Disease Physician	30015	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060057636	OTHER	IN	RAILROAD MEDICARE/MADISON
8	P01333108	OTHER	KY	MEDICARE RR-CTS
12	060052920	OTHER		RAILROAD MEDICARE TVILLE
18	060052923	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3121962	OTHER		BCBS TENNESSEE
4	159683	OTHER	KY	SIHO-CTS
5	415633P	OTHER	IN	SIHO
6	1169908	OTHER		CHA PROVIDER NETWORK
7	835778	OTHER		FIRST HEALTH
9	000000867525	OTHER	KY	ANTHEM-CTS
10	299856	OTHER		FEDERAL BLACK LUNG PROGRA
11	50065353	OTHER	KY	PASSPORT-CTS
13	2552053001	OTHER		CIGNA
14	000000052136	OTHER	KY	ANTHEM BCBS
15	1079152	OTHER		PASSPORT HEALTH PLAN
16	25-00439	OTHER	KY	UNITED HEALTHCARE
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
19	6113371060A11	OTHER		ANTHEM SR. ADVANTAGE

General Provider Information

NPI Number	:	1134205735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIO M STIKOVAC M.D.

Provider Business Mailing Address
First Line	:	4700 LAS VEGAS BLVD N
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191
Country	:	US
Telephone Number	:	702-653-3257
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 LAS VEGAS BLVD N
Second Line	:
City	:	NELLIS AFB
State	:	NV
Zip	:	89191
Country	:	US
Telephone Number	:	702-653-3257
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/16/2018

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Directions to “ MIO M STIKOVAC M.D.” Practice Location

Language	Start Address	Practice Location

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