Provider Demographics
NPI:1053382416
Name:MILJKOVIC, GORAN (MD)
Entity type:Individual
Prefix:DR
First Name:GORAN
Middle Name:
Last Name:MILJKOVIC
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 1:3241 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4850
Mailing Address - Country:US
Mailing Address - Phone:203-383-4466
Mailing Address - Fax:203-383-4499
Practice Address - Street 1:3241 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4850
Practice Address - Country:US
Practice Address - Phone:203-383-4466
Practice Address - Fax:203-383-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039614207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001396143Medicaid
CT001396143-00OtherBLUECARE FAMILY PLAN
CT010039614CT03OtherBLUE CROSS
CT198599/241469OtherWELLCARE
CT2V0848OtherHEALTHNET
CT001396143OtherCHN
CT069614OtherCT CARE
CT110243501OtherRAILROAD MEDICARE
CT061608343OtherUNITED HEALTHCARE
CTP2522396OtherOXFORD
CT001396143OtherFIRST CHOICE
CT2807118/2843349OtherAETNA
CT001396143OtherFIRST CHOICE
CT010039614CT03OtherBLUE CROSS