Provider Demographics
NPI:1538345848
Name:KRNJAIC, NADA (MD)
Entity type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:KRNJAIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E VIRGINIA AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1210
Mailing Address - Country:US
Mailing Address - Phone:602-258-3122
Mailing Address - Fax:602-258-3119
Practice Address - Street 1:333 E VIRGINIA AVE STE 214
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1210
Practice Address - Country:US
Practice Address - Phone:602-258-3122
Practice Address - Fax:602-258-3119
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381-640Medicaid
AZZ20577Medicare PIN