Provider Demographics
NPI:1962704445
Name:MANDICH, MILJANA (MD)
Entity type:Individual
Prefix:DR
First Name:MILJANA
Middle Name:
Last Name:MANDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4707
Mailing Address - Country:US
Mailing Address - Phone:504-486-4201
Mailing Address - Fax:504-488-9659
Practice Address - Street 1:618 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4707
Practice Address - Country:US
Practice Address - Phone:504-486-4201
Practice Address - Fax:504-488-9659
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine