Provider Demographics
NPI:1194974824
Name:TANCEVSKI, ALEKSANDAR (MD)
Entity type:Individual
Prefix:DR
First Name:ALEKSANDAR
Middle Name:
Last Name:TANCEVSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9142
Mailing Address - Country:US
Mailing Address - Phone:740-788-9220
Mailing Address - Fax:740-522-8070
Practice Address - Street 1:2750 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9142
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6186
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP SUBMITTED 7/08207X00000X
FLME114829207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077235Medicaid
FL008904700Medicaid
FL14P3UOtherBCBS