Basic Information
| Provider Information | |||||||||
| NPI: | 1659330199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PREDANIC | ||||||||
| FirstName: | MLADEN | ||||||||
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| Credential: | MD MSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9101 LBJ FWY STE 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752431912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2460 N INTERSTATE HIGHWAY 35 E STE 165 | ||||||||
| Address2: | |||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145062617 | ||||||||
| FaxNumber: | 9727884707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 07/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 218183 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | N4680 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 218183 | NY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VX0000X | N4680 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VM0101X | N4680 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.