MEDICARE: KRISTA M ZIVKOVIC D.O.

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	207Q00000X	Family Medicine Physician	OS8669	FL

General Provider Information

NPI Number	:	1285625889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA M ZIVKOVIC D.O.

Provider Business Mailing Address
First Line	:	949 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	239-772-7202
Fax Number	:	239-242-0457

Provider Business Practice Location Address
First Line	:	949 CHIQUITA BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2143
Country	:	US
Telephone Number	:	239-772-7202
Fax Number	:	239-242-0457

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/17/2014

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