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1750452801 NPI number — KSENIJA MODRIC JEDNACAK M.D.

NPI Number: 1750452801
Health Care Provider/Practitioner: KSENIJA MODRIC JEDNACAK M.D.

Information about “1750452801” NPI (KSENIJA MODRIC JEDNACAK M.D.) exists in 1750452801 in HTML format HTML  |  1750452801 in plain Text format TXT  |  1750452801 in PDF (Portable Document Format) PDF  |  1750452801 in an XML format XML  formats.

NPI Number : 1750452801 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750452801",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MODRIC JEDNACAK",
    "FirstName": "KSENIJA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MODRIC",
    "OtherFirstName": "KSENIJA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "6726 CEDAR ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAUWATOSA",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53213-3254",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "414-774-4074",
    "MailingAddressFaxNumber": "414-774-0471",
    "FirstLinePracticeLocationAddress": "6726 CEDAR ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WAUWATOSA",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53213-3254",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-774-4074",
    "PracticeLocationAddressFaxNumber": "414-774-0471",
    "EnumerationDate": "11/12/2006",
    "LastUpdateDate": "02/06/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207L00000X",
        "TaxonomyName": "Anesthesiology Physician",
        "LicenseNumber": "47908-020",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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