Provider Demographics
NPI:1437413168
Name:DIMITRIJEVIC, MIRJANA (MD)
Entity Type:Individual
Prefix:
First Name:MIRJANA
Middle Name:
Last Name:DIMITRIJEVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3803
Mailing Address - Country:US
Mailing Address - Phone:586-218-5800
Mailing Address - Fax:586-218-5808
Practice Address - Street 1:18001 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-218-5800
Practice Address - Fax:586-218-5808
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2258453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine