Healthcare Provider Details

I. General information

NPI: 1639228075
Provider Name (Legal Business Name): DJUROVIC MEDICAL CLINIC,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W 86TH AVE STE C
MERRILLVILLE IN
46410-6192
US

IV. Provider business mailing address

155 W 86TH AVE STE C
MERRILLVILLE IN
46410-6192
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-3233
  • Fax:
Mailing address:
  • Phone: 219-769-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01026620
License Number StateIN

VIII. Authorized Official

Name: NADEZDA DJUROVIC
Title or Position: MD
Credential:
Phone: 219-769-3233