Provider Demographics
NPI:1043573371
Name:MIJIC, DRAGOMIR (DO)
Entity Type:Individual
Prefix:
First Name:DRAGOMIR
Middle Name:
Last Name:MIJIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3406
Mailing Address - Country:US
Mailing Address - Phone:954-958-4800
Mailing Address - Fax:954-351-7873
Practice Address - Street 1:7544 JACQUE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7162
Practice Address - Country:US
Practice Address - Phone:727-697-2200
Practice Address - Fax:727-857-4397
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019993207X00000X
FLOS14483207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty