Provider Demographics
NPI:1801836283
Name:GRACANIN, LUDMILA MARIA (MD)
Entity type:Individual
Prefix:
First Name:LUDMILA
Middle Name:MARIA
Last Name:GRACANIN
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 1:2841 BLUE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6334
Mailing Address - Country:US
Mailing Address - Phone:513-923-3500
Mailing Address - Fax:513-923-4464
Practice Address - Street 1:2841 BLUE ROCK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6334
Practice Address - Country:US
Practice Address - Phone:513-923-3500
Practice Address - Fax:513-923-4464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH65942OtherHUMANA
OH000000036270OtherANTHEM
OH0116921Medicaid
OH70417OtherAETNA
OH0403144OtherUNITED HEALTHCARE
OH000000036270OtherANTHEM
OH0116921Medicaid