Healthcare Provider Details

I. General information

NPI: 1255364378
Provider Name (Legal Business Name): JOHN N DIDOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

720 LAKE RD
MIAMI FL
33137-3331
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2680
  • Fax: 305-674-3919
Mailing address:
  • Phone: 305-674-2680
  • Fax: 305-674-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME72013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME72013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: