MEDICARE: VJEKOSLAV MIKELIC M.D.

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	2085R0202X	Diagnostic Radiology Physician	4301034048	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	300008865	OTHER		RR MEDICARE/PALMETTO GBA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H26188	OTHER	MI	BCBS PROVIDER NUMBER
2	1006439	OTHER	MI	MCLAREN HEALTH
4	0Q26008	OTHER	MI	BCBS PROVIDER NUMBER
5	0Q26008002	OTHER		FED BLACK LUNG PROGRAM
6	0H26188002	OTHER		FED BLACK LUNG PROGRAM
7	117547	OTHER	MI	GREAT LAKES HEALTH
8	136658710	OTHER	MI	PROCARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518946748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VJEKOSLAV MIKELIC M.D.

Provider Business Mailing Address
First Line	:	51307 GRATIOT AVE
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48051-2079
Country	:	US
Telephone Number	:	586-741-3772
Fax Number	:	586-741-4604

Provider Business Practice Location Address
First Line	:	22101 MOROSS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48236-2148
Country	:	US
Telephone Number	:	313-343-3248
Fax Number	:	586-741-4604

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	09/19/2025

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Directions to “ VJEKOSLAV MIKELIC M.D.” Practice Location

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