Provider Demographics
NPI:1346269263
Name:KADIJEVIC, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:KADIJEVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CHURCHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6577
Mailing Address - Country:US
Mailing Address - Phone:704-968-6479
Mailing Address - Fax:
Practice Address - Street 1:1328 PATTERSON STREET
Practice Address - Street 2:UNION PEDIATRICS
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112
Practice Address - Country:US
Practice Address - Phone:704-283-2000
Practice Address - Fax:704-225-0885
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140J8OtherBCBS
NC5901516Medicaid
SCN01082Medicaid
NCI39598Medicare UPIN