Provider Demographics
NPI:1861679706
Name:KOVACEVIC, IDRIZ (MD)
Entity Type:Individual
Prefix:MR
First Name:IDRIZ
Middle Name:
Last Name:KOVACEVIC
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 1:9105 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2248
Mailing Address - Country:US
Mailing Address - Phone:305-496-8079
Mailing Address - Fax:
Practice Address - Street 1:9105 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33150-2248
Practice Address - Country:US
Practice Address - Phone:305-496-8079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL421582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry