Provider Demographics
NPI:1558620591
Name:DUSAN DRAGOVIC, MD, FASN, LLC
Entity Type:Organization
Organization Name:DUSAN DRAGOVIC, MD, FASN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-420-9908
Mailing Address - Street 1:5300 W HILLSBORO BLVD
Mailing Address - Street 2:206
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4395
Mailing Address - Country:US
Mailing Address - Phone:954-420-9908
Mailing Address - Fax:
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:206
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:954-420-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89623207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
48375Medicare UPIN