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General NPI Number Information
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NPI Number | 1639228075
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Entity Type | Organization
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Legal Business Name | DJUROVIC MEDICAL CLINIC,P.C.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 155 W 86TH AVE STE C
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6192
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Country | US
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Telephone | 219-769-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 155 W 86TH AVE STE C
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6192
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Country | US
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Telephone | 219-769-3233
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Fax |
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Authorized Official
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Title or Position | MD
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Name | NADEZDA DJUROVIC
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Credential |
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Telephone | 219-769-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01026620
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License Number State | IN
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