MEDICARE: JOHN N DIDOVIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	ME72013	FL
2	2085R0202X	Diagnostic Radiology Physician	ME72013	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	35627	OTHER	FL	BCBSF

General Provider Information

NPI Number	:	1255364378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN N DIDOVIC MD

Provider Business Mailing Address
First Line	:	720 LAKE RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3331
Country	:	US
Telephone Number	:	305-674-2680
Fax Number	:	305-674-3919

Provider Business Practice Location Address
First Line	:	4300 ALTON RD
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2948
Country	:	US
Telephone Number	:	305-674-2680
Fax Number	:	305-674-3919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/09/2016

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Directions to “ JOHN N DIDOVIC MD” Practice Location

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