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General NPI Number Information
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NPI Number | 1184855611
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Entity Type | Individual
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Provider Name | IVICA BOBAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 9969 S 27TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-9533
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Country | US
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Telephone | 414-325-4950
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Fax | 414-325-4951
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Provider Business Mailing Address
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Address Line | 9969 S 27TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-9533
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Country | US
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Telephone | 414-325-4950
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Fax | 414-325-4951
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 53424-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 53424-20
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License Number State | WI
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