Provider Demographics
NPI:1457634263
Name:MIGUEL DEJUK, PC
Entity Type:Organization
Organization Name:MIGUEL DEJUK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:GAZEL
Authorized Official - Last Name:DEJUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-328-8668
Mailing Address - Street 1:800 ZEAGLER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3827
Mailing Address - Country:US
Mailing Address - Phone:386-328-8668
Mailing Address - Fax:386-328-3767
Practice Address - Street 1:800 ZEAGLER DR STE 210
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3827
Practice Address - Country:US
Practice Address - Phone:386-328-8668
Practice Address - Fax:386-328-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0055591207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty