Provider Demographics
NPI:1154625887
Name:AVDAGIC, MIRHA (MD)
Entity type:Individual
Prefix:
First Name:MIRHA
Middle Name:
Last Name:AVDAGIC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3619 RICHARDSON SQUARE DR
Mailing Address - Street 2:STE 170
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6022
Mailing Address - Country:US
Mailing Address - Phone:636-717-6776
Mailing Address - Fax:314-525-4055
Practice Address - Street 1:3619 RICHARDSON SQUARE DR
Practice Address - Street 2:STE 170
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6022
Practice Address - Country:US
Practice Address - Phone:636-717-6776
Practice Address - Fax:314-525-4055
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10033051207Q00000X
MO2011025918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine