Provider Demographics
NPI:1205497542
Name:MATIJEVIC, DEJAN (ND)
Entity type:Individual
Prefix:DR
First Name:DEJAN
Middle Name:
Last Name:MATIJEVIC
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 E TURNEY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4417
Mailing Address - Country:US
Mailing Address - Phone:623-200-7557
Mailing Address - Fax:
Practice Address - Street 1:6029 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1802
Practice Address - Country:US
Practice Address - Phone:602-252-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ197872083B0002X, 2083P0901X, 2083S0010X, 208D00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice