Provider Demographics
NPI:1477644573
Name:KLISOVIC, DINO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:DANIEL
Last Name:KLISOVIC
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 1:6655 POST RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8214
Mailing Address - Country:US
Mailing Address - Phone:614-339-8500
Mailing Address - Fax:614-339-8501
Practice Address - Street 1:6655 POST RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8214
Practice Address - Country:US
Practice Address - Phone:614-339-8500
Practice Address - Fax:614-339-8501
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078405207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000370725OtherANTHEM
OH7846761OtherAETNA
OH2636731Medicaid
OH000000370725OtherANTHEM
OH7846761OtherAETNA
OHKL4167736Medicare PIN