Basic Information
| Provider Information | |||||||||
| NPI: | 1639110877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANKOVIC | ||||||||
| FirstName: | LANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51 ROSELANE STREET NW | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | MARIETTTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707940477 | ||||||||
| FaxNumber: | 7707943108 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 ROSELANE STREET NW | ||||||||
| Address2: | SUITE 750 | ||||||||
| City: | MARIETTTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707940477 | ||||||||
| FaxNumber: | 7707943108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25350 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 055186 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 009949135 | 05 | AL | MEDICAID | 051520796 | 01 | AL | BLUE CROSS | OTHER | 010033CH72657 | 01 | AL | SECTION 1011 | OTHER | 051520798 | 01 | AL | BLUE CROSS | OTHER | 009947365 | 05 | AL | MEDICAID | 051520797 | 01 | AL | BLUE CROSS | OTHER | 07833224 | 01 | MS | MISSISSIPPI MEDICAID | OTHER | P00215395 | 01 | AL | RAILROAD MEDICARE | OTHER |