Provider Demographics
NPI:1962061879
Name:WANDERSLEBEN MIHOVILOVIC, GERT HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:GERT
Middle Name:HAROLD
Last Name:WANDERSLEBEN MIHOVILOVIC
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0155
Mailing Address - Country:US
Mailing Address - Phone:787-951-7420
Mailing Address - Fax:
Practice Address - Street 1:IPA 513 CALLE MAYAGUEZ
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-764-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21376208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice