MEDICARE: DALIBOR TOMLJENOVIC RN

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	163W00000X	Registered Nurse	RN.392567	OH
2	163W00000X	Registered Nurse	4704338414	MI

General Provider Information

NPI Number	:	1477169951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALIBOR TOMLJENOVIC RN

Provider Business Mailing Address
First Line	:	540 JENNER DR
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-1517
Country	:	US
Telephone Number	:	269-633-9655
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 JENNER DR
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-1517
Country	:	US
Telephone Number	:	269-633-9655
Fax Number	:

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

Provider Enumeration Date	:	09/19/2020
Last Update Date	:	03/02/2026

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