Healthcare Provider Details

I. General information

NPI: 1073710018
Provider Name (Legal Business Name): NATASA MIHIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

IV. Provider business mailing address

871 CORONADO CENTER DR STE 141
HENDERSON NV
89052-3977
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-2400
  • Fax: 702-433-2477
Mailing address:
  • Phone: 702-566-2400
  • Fax: 702-433-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81940
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13615
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: