Healthcare Provider Details

I. General information

NPI: 1598509689
Provider Name (Legal Business Name): MIKELINA DJEKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 STONE ST
SAGINAW MI
48602
US

IV. Provider business mailing address

47663 FALCON DR
SHELBY TOWNSHIP MI
48315-5008
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: