Provider Demographics
NPI:1740369222
Name:SKLIZOVIC, DAVOR GRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:DAVOR
Middle Name:GRAHAM
Last Name:SKLIZOVIC
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 1:50 UNION ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5658
Mailing Address - Fax:207-664-5758
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-664-5658
Practice Address - Fax:207-664-5758
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20267207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040017245OtherMEDICARE RAILROAD
040017245OtherMEDICARE RAILROAD
7182Medicare ID - Type Unspecified