MEDICARE: BERISLAV SPAHIJA,M.D., INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	3580889	OH
2	2084N0400X	Neurology Physician	35077285	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	130021621	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0500696	OTHER		UNTED HEALTHCARE
2	218165	OTHER		UPMC
4	18076961300	OTHER		MMOH
5	774691	OTHER		BS PA
6	000000142099	OTHER	OH	ANTHEM
7	1047518	OTHER		WV COMP
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	26386	OTHER		INDIANA HEALTH PLAN
10	P77285	OTHER		HEALTH PLAN
11	000520339	OTHER		BC BS PA
12	95840	OTHER		QUALCHOICE
13	2260699	OTHER		AETNA
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609941392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERISLAV SPAHIJA,M.D., INC.

Provider Business Mailing Address
First Line	:	16687 SAINT CLAIR AVE
Second Line	:	SUITE 201
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9401
Country	:	US
Telephone Number	:	330-382-1070
Fax Number	:	330-382-0916

Provider Business Practice Location Address
First Line	:	16687 SAINT CLAIR AVE
Second Line	:	SUITE 201
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9401
Country	:	US
Telephone Number	:	330-382-1070
Fax Number	:	330-382-0916

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BERISLAV SPAHIJA
Credential	:	M.D.
Telephone Number	:	330-382-1070

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/01/2008

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Directions to “BERISLAV SPAHIJA,M.D., INC. ” Practice Location

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