MEDICARE: MARKO JOVANOVSKI PA-C

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	363A00000X	Physician Assistant	5601009032	MI

General Provider Information

NPI Number	:	1316404403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKO JOVANOVSKI PA-C

Provider Business Mailing Address
First Line	:	1221 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3511
Country	:	US
Telephone Number	:	810-989-3300
Fax Number	:	810-985-2671

Provider Business Practice Location Address
First Line	:	1221 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3511
Country	:	US
Telephone Number	:	810-989-3300
Fax Number	:	810-985-2671

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

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	12/20/2025

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