Healthcare Provider Details

I. General information

NPI: 1093776254
Provider Name (Legal Business Name): MIROSLAV CUTURIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MEDICAL PARK DRIVE SUITE 420
COLUMBIA SC
29203-8003
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-565-6050
  • Fax: 803-565-6051
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-293-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19766
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number19766
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: