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General NPI Number Information
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NPI Number | 1033596663
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Entity Type | Individual
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Provider Name | ANA MILOSEVIC MICHUNOVICH D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 4800 E JOHNSON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-8413
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Country | US
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Telephone | 708-936-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 361 SOUTHWEST DR # 107
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City | JONESBORO
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State | AR
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Zip | 72401-5854
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Country | US
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Telephone | 602-334-0602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | E-12183
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License Number State | AR
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