Provider Demographics
NPI:1487606067
Name:SPAHIJA, BERISLAV (MD)
Entity type:Individual
Prefix:MR
First Name:BERISLAV
Middle Name:
Last Name:SPAHIJA
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 1:110 E CENTER ST # 2595
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2908
Mailing Address - Country:US
Mailing Address - Phone:701-204-1130
Mailing Address - Fax:
Practice Address - Street 1:222 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4436
Practice Address - Country:US
Practice Address - Phone:701-323-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350772852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1047518OtherWORKERS COMP
130021621OtherRAILROAD MEDICARE
OH34190968600OtherWORKERS COMP
PA774691OtherBS
OH1510739OtherGATEWAY
2260699OtherAETNA
0500696OtherUNITED HEALTHCARE
OH2150390Medicaid
OH2745739Medicaid
WV6120037000Medicaid
P77285OtherHEALTH PLAN UPPER OH VALL
OH000000142099OtherANTHEM
PA000520339OtherBCBS
95840OtherQUAL CHOICE
OH341909686026OtherCARESOURCE
WV1047518OtherWORKERS COMP
H07699Medicare UPIN
OH34190968600OtherWORKERS COMP
WV6120037000Medicaid
OH9346841Medicare PIN