Provider Demographics
NPI:1255535472
Name:HAJDUKOVIC, DINKO (DPM)
Entity type:Individual
Prefix:DR
First Name:DINKO
Middle Name:
Last Name:HAJDUKOVIC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38859 SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7223
Mailing Address - Country:US
Mailing Address - Phone:440-946-5668
Mailing Address - Fax:
Practice Address - Street 1:38859 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7223
Practice Address - Country:US
Practice Address - Phone:440-946-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2988213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0532301Medicaid
OH0532301Medicaid
OHU25002Medicare UPIN