Healthcare Provider Details

I. General information

NPI: 1477997484
Provider Name (Legal Business Name): MIROSLAV SEKULIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, PTH 5077
CLEVELAND OH
44106-4410
US

IV. Provider business mailing address

11100 EUCLID AVENUE UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER, PTH 5077
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 804-677-1280
  • Fax:
Mailing address:
  • Phone: 804-677-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.134562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: