Provider Demographics
NPI:1174867899
Name:ADVANCED DIGITAL ANATOMIC PATHOLOGY TECHNOLOGIES, PLLC
Entity Type:Organization
Organization Name:ADVANCED DIGITAL ANATOMIC PATHOLOGY TECHNOLOGIES, PLLC
Other - Org Name:ADAPT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAZEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUKIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD PH D
Authorized Official - Phone:813-558-8170
Mailing Address - Street 1:27716 CASHFORD CIR
Mailing Address - Street 2:STE 101C
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6962
Mailing Address - Country:US
Mailing Address - Phone:813-669-9113
Mailing Address - Fax:
Practice Address - Street 1:27716 CASHFORD CIR
Practice Address - Street 2:STE 101C
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6962
Practice Address - Country:US
Practice Address - Phone:813-669-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEL095AOtherMEDICARE PTAN