Provider Demographics
NPI:1184703621
Name:KOSTIC, BILJANA (MD)
Entity type:Individual
Prefix:DR
First Name:BILJANA
Middle Name:
Last Name:KOSTIC
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 1:41120 WASHINGTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9596
Mailing Address - Country:US
Mailing Address - Phone:760-772-2823
Mailing Address - Fax:760-772-2819
Practice Address - Street 1:41120 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9596
Practice Address - Country:US
Practice Address - Phone:760-772-2823
Practice Address - Fax:760-772-2819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO52597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62424Medicare UPIN