Provider Demographics
NPI:1083145171
Name:DIMITROFF, DAVID JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:DIMITROFF
Suffix:JR
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 1:1610 CALUMET AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3328
Mailing Address - Country:US
Mailing Address - Phone:219-462-4655
Mailing Address - Fax:219-462-2491
Practice Address - Street 1:1610 CALUMET AVE STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3328
Practice Address - Country:US
Practice Address - Phone:219-462-4655
Practice Address - Fax:219-462-2491
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083263A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics