MEDICARE: MEHMED ZELJKOVIC PA

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	4762666-1206	UT

General Provider Information

NPI Number	:	1871068320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHMED ZELJKOVIC PA

Provider Business Mailing Address
First Line	:	1969 S 1700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3156
Country	:	US
Telephone Number	:	801-450-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1969 S 1700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-3156
Country	:	US
Telephone Number	:	801-450-6670
Fax Number	:

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

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	12/20/2021

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