Healthcare Provider Details

I. General information

NPI: 1508830076
Provider Name (Legal Business Name): STEVANOVIC CLINICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 W OKLAHOMA AVE
WEST ALLIS WI
53227-4033
US

IV. Provider business mailing address

11111 W OKLAHOMA AVE
WEST ALLIS WI
53227-4033
US

V. Phone/Fax

Practice location:
  • Phone: 414-546-8000
  • Fax: 414-546-2909
Mailing address:
  • Phone: 414-546-8000
  • Fax: 414-546-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number39372
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number39372
License Number StateWI

VIII. Authorized Official

Name: DR. NEBOJSA STEVANOVIC
Title or Position: MD
Credential: MD
Phone: 414-546-8000