Provider Demographics
NPI:1821894759
Name:DJURIC, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:DJURIC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22163 COUNTY STREET 2700
Mailing Address - Street 2:
Mailing Address - City:GRACEMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73042-9513
Mailing Address - Country:US
Mailing Address - Phone:570-242-0605
Mailing Address - Fax:
Practice Address - Street 1:600 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9432
Practice Address - Country:US
Practice Address - Phone:102-940-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician