Provider Demographics
NPI:1093875403
Name:DRAGOVIC, JADRANKA (MD)
Entity Type:Individual
Prefix:
First Name:JADRANKA
Middle Name:
Last Name:DRAGOVIC
Suffix:
Gender:F
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:2799 W.GRAND BLVD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-640-2400
Mailing Address - Fax:313-640-2410
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2799 W.GRAND BLVD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-640-2400
Practice Address - Fax:313-640-2410
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0481512085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
JD048151OtherCOMMERCIAL-COMMERCIAL NUMBER
MI192564910Medicaid
700H262320OtherBLUE CROSS-BLUE CROSS
JD048151OtherCHAMPUS-CHAMPUS
JD048151OtherCOMMERCIAL-COMMERCIAL NUMBER
B48693Medicare UPIN