Physician Compare National (NPI:1245341791)

HEALTHCARE PROVIDER: JOHN KEVIN MIRJANICH MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1245341791
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698848398
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100625000461
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MIRJANICH
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF OKLAHOMA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	ANESTHESIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2825 PARKLAWN DR
	Group Practice or individual's line 1 address
City	MIDWEST CITY
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	731104201
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4056108143
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	370037
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ANTHONY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	370094
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALLIANCEHEALTH MIDWEST
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y