Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | E-12183 | AR |
NPI | 1033596663 |
---|---|
Provider Name | Ana Milosevic Michunovich |
First Address | Jonesboro, AR 72401-5854 |
Second Address | Jonesboro, AR 72401-8413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 10/06/2019 |