Provider Demographics
NPI:1073515961
Name:DOBROVICH, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DOBROVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:29325 HEALTH CAMPUS DR
Practice Address - Street 2:STE 2
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8201
Practice Address - Country:US
Practice Address - Phone:440-835-6142
Practice Address - Fax:440-899-4383
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34003798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0618415Medicaid
OH110053940OtherRR MEDICARE
OHE00706Medicare UPIN
OH0618415Medicaid
OH110053940OtherRR MEDICARE
OH0596524Medicare PIN