Provider Demographics
NPI:1275075137
Name:MIRJANIC, DUSKO (RSA)
Entity Type:Individual
Prefix:MR
First Name:DUSKO
Middle Name:
Last Name:MIRJANIC
Suffix:
Gender:M
Credentials:RSA
Other - Prefix:MR
Other - First Name:DUSKO
Other - Middle Name:
Other - Last Name:MIRJANIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RSA
Mailing Address - Street 1:133 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1177
Mailing Address - Country:US
Mailing Address - Phone:219-682-8268
Mailing Address - Fax:
Practice Address - Street 1:133 HOLLY LN
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1177
Practice Address - Country:US
Practice Address - Phone:219-682-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000482246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant