Provider Demographics
NPI:1154066793
Name:MILADINOVIC, DEJAN
Entity Type:Individual
Prefix:
First Name:DEJAN
Middle Name:
Last Name:MILADINOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 W JOHN CABOT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7709
Mailing Address - Country:US
Mailing Address - Phone:623-326-4229
Mailing Address - Fax:
Practice Address - Street 1:9224 W JOHN CABOT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7709
Practice Address - Country:US
Practice Address - Phone:623-326-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156222163WD0400X, 163WI0500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy