MEDICARE: MLADEN PANIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	373H00000X	Day Training/Habilitation Specialist
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1609388156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MLADEN PANIC

Provider Business Mailing Address
First Line	:	1803 W MARCH LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6458
Country	:	US
Telephone Number	:	209-636-5355
Fax Number	:	209-636-5356

Provider Business Practice Location Address
First Line	:	1803 W MARCH LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-6458
Country	:	US
Telephone Number	:	209-636-5355
Fax Number	:	209-636-5356

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

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	01/14/2026

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Directions to “ MLADEN PANIC ” Practice Location

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