Healthcare Provider Details

I. General information

NPI: 1225045800
Provider Name (Legal Business Name): TODOR TODE DRAGICEVIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 8TH AVE SE
MINOT ND
58701-4935
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5998
  • Fax: 701-857-5022
Mailing address:
  • Phone: 701-857-7033
  • Fax: 701-857-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPT10318
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: