Provider Demographics
NPI:1255364378
Name:DIDOVIC, JOHN N (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:DIDOVIC
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 1:720 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3331
Mailing Address - Country:US
Mailing Address - Phone:305-674-2680
Mailing Address - Fax:305-674-3919
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2680
Practice Address - Fax:305-674-3919
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME720132085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260402700Medicaid
FL35627OtherBCBSF
FL35627XMedicare PIN
FL260402700Medicaid