Provider Demographics
NPI:1871548024
Name:TUCAKOVIC, MILOS (MD)
Entity type:Individual
Prefix:
First Name:MILOS
Middle Name:
Last Name:TUCAKOVIC
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 1:3320 OLD JEFFERSON ROAD
Mailing Address - Street 2:BLDG 200 STE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-353-0636
Practice Address - Street 1:3320 OLD JEFFERSON ROAD
Practice Address - Street 2:BLDG 200 STE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-353-0636
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59221207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018906500001Medicaid
GA059880494AMedicaid
GA059880494AMedicaid
GAH59370Medicare UPIN
PA56713Medicare ID - Type Unspecified