Provider Demographics
NPI:1639228075
Name:DJUROVIC MEDICAL CLINIC,P.C.
Entity Type:Organization
Organization Name:DJUROVIC MEDICAL CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NADEZDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DJUROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-769-3233
Mailing Address - Street 1:155 W 86TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6192
Mailing Address - Country:US
Mailing Address - Phone:219-769-3233
Mailing Address - Fax:
Practice Address - Street 1:155 W 86TH AVE STE C
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6192
Practice Address - Country:US
Practice Address - Phone:219-769-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28924Medicare UPIN
IN178520Medicare ID - Type Unspecified