Provider Demographics
NPI:1134146905
Name:SKRTIC, ZDRAVKO (MD)
Entity type:Individual
Prefix:
First Name:ZDRAVKO
Middle Name:
Last Name:SKRTIC
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501
Mailing Address - Country:US
Mailing Address - Phone:616-364-6700
Mailing Address - Fax:616-364-4960
Practice Address - Street 1:200 JEFFERSON SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-364-6700
Practice Address - Fax:616-364-4960
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010577282085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300102754OtherRR MEDICARE
MI3338723100Medicaid
G29763Medicare UPIN