Healthcare Provider Details

I. General information

NPI: 1952632440
Provider Name (Legal Business Name): MILAN P. KRICKOVIC, M.D., LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 FOREST AVE SUITE 109
RICHMOND VA
23229-4938
US

IV. Provider business mailing address

7605 FOREST AVE SUITE 109
RICHMOND VA
23229-4938
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8313
  • Fax: 804-287-4365
Mailing address:
  • Phone: 804-288-8313
  • Fax: 804-287-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MILAN PIERSOL KRICKOVIC
Title or Position: PRESIDENT OF CORPORATION/PHYSICIAN
Credential: M.D.
Phone: 804-288-8313