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General NPI Number Information
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NPI Number | 1003055252
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Entity Type | Individual
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Provider Name | OLIVER DIMITRIJEVIC MD
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Gender | Male
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 27450 SCHOENHERR RD SUITE 500
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City | WARREN
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State | MI
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Zip | 48088-6683
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Country | US
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Telephone | 586-582-7632
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Fax | 586-582-7633
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Provider Business Mailing Address
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Address Line | 19251 MACK AVE SUITE 333
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-2893
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Country | US
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Telephone | 313-343-7280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01079000A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301089472
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License Number State | MI
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