Provider Demographics
NPI:1255308615
Name:DUSEVIC, TAMMY SAMUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SAMUEL
Last Name:DUSEVIC
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:13425 19 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1991
Mailing Address - Country:US
Mailing Address - Phone:586-843-3935
Mailing Address - Fax:586-843-3947
Practice Address - Street 1:13425 19 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313
Practice Address - Country:US
Practice Address - Phone:586-843-3935
Practice Address - Fax:586-843-3947
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255308615Medicaid
MI1255308615Medicaid
MIE06335035Medicare PIN