Healthcare Provider Details

I. General information

NPI: 1124600168
Provider Name (Legal Business Name): RAJKA MICIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N STONE ST
DELAND FL
32720-3255
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-1824
  • Fax: 386-738-7497
Mailing address:
  • Phone: 954-967-6400
  • Fax: 954-337-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME167259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: