MEDICARE: SANJA COSIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME67362	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174517718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJA COSIC MD

Provider Business Mailing Address
First Line	:	5001 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5303
Country	:	US
Telephone Number	:	813-984-8846
Fax Number	:	813-988-8827

Provider Business Practice Location Address
First Line	:	5001 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5303
Country	:	US
Telephone Number	:	813-984-8846
Fax Number	:	813-988-8827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	10/19/2020

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Directions to “ SANJA COSIC MD” Practice Location

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