Provider Demographics
NPI:1629451901
Name:SLAVNIC, DEJAN (DO)
Entity Type:Individual
Prefix:
First Name:DEJAN
Middle Name:
Last Name:SLAVNIC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NIKKI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4868
Mailing Address - Country:US
Mailing Address - Phone:813-444-5567
Mailing Address - Fax:
Practice Address - Street 1:42758 GEORGETOWN
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1766
Practice Address - Country:US
Practice Address - Phone:773-551-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022109207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery