MEDICARE: ZIVKOVIC FAMILY MEDICINE, P.A.

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	207Q00000X	Family Medicine Physician	OS8669	FL

General Provider Information

NPI Number	:	1932524113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZIVKOVIC FAMILY MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	949 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	239-772-7202
Fax Number	:	239-424-0457

Provider Business Practice Location Address
First Line	:	949 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	239-772-7202
Fax Number	:	239-424-0457

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRISTA M ZIVKOVIC
Credential	:	D.O.
Telephone Number	:	239-772-7202

Provider Enumeration Date	:	02/25/2014
Last Update Date	:	07/17/2014

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