Healthcare Provider Details

I. General information

NPI: 1003055252
Provider Name (Legal Business Name): OLIVER DIMITRIJEVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 SCHOENHERR RD SUITE 500
WARREN MI
48088-6683
US

IV. Provider business mailing address

19251 MACK AVE SUITE 333
GROSSE POINTE WOODS MI
48236-2893
US

V. Phone/Fax

Practice location:
  • Phone: 586-582-7632
  • Fax: 586-582-7633
Mailing address:
  • Phone: 313-343-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01079000A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301089472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: