Healthcare Provider Details

I. General information

NPI: 1740780048
Provider Name (Legal Business Name): MILICA DJORDJEVIC BA, MSSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11890 FAIRHILL RD
CLEVELAND OH
44120-1053
US

IV. Provider business mailing address

11890 FAIRHILL RD
CLEVELAND OH
44120-1053
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-8000
  • Fax: 216-373-1820
Mailing address:
  • Phone: 216-791-8000
  • Fax: 216-373-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: