Milan Edward Ivancic, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

08988 Issued in MS

Practice address

499 Gloster Creek VLG
Suite H-3
Tupelo, MS 38801-4600

Phone

(662) 840-6026

Fax

(662) 840-6030

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivancic Pediatric Clinic PA

  • Primary Care Clinic/Center
  • Tupelo, MS
  • NPI 1942606256
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1023034477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE H-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-840-6026",
            "fax_number": "662-840-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 GLOSTER CREEK VLG",
            "address_2": "SUITE H-3",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014600",
            "telephone_number": "662-840-6026",
            "fax_number": "662-840-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANCIC",
        "first_name": "MILAN",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "08988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00111471",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovative Prosthetic Care Tupelo LLC
• Thomas A Ireland, M.D.
• David H Irwin Jr., MD
• Robert Bryson Irwin, M.D.
• Ivancic Pediatric Clinic PA
• Donavan Ivy
• Lakeisha Denise Ivy, M.ED.
• Quanashetia McKinney Ivy, BSW
• Ulaunda Ivy, MSCE
• Iwueke Psychatric Clinic

• Pediatrics Physician in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.