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Individual
DEJAN MAKSIMOVIC
Active
Individual
DEJAN MAKSIMOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036124188
IL
207Q00000X
Family Medicine Physician
56981
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP PTAN
IL
01
—
809840038
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
06/29/2007
Last updated
10/06/2014
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