Provider Demographics
NPI:1003055252
Name:DIMITRIJEVIC, OLIVER (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:DIMITRIJEVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19251 MACK AVE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2893
Mailing Address - Country:US
Mailing Address - Phone:313-343-7280
Mailing Address - Fax:
Practice Address - Street 1:27450 SCHOENHERR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6683
Practice Address - Country:US
Practice Address - Phone:586-582-7632
Practice Address - Fax:586-582-7633
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079000A208M00000X
MI4301089472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBS GROUP NUMBER
MI700E012740OtherBCBS GROUP NUMBER