Individual
LIDIJA PETROVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1510 SAN PABLO ST FL 6, LOS ANGELES, CA 90033-5320
(323) 442-4815
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-2582
(323) 442-2588
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
226218
NY
207ZP0101X
Anatomic Pathology Physician
Primary
A52273
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0101420
GROUP MEDICAID #
CA
01
—
GR0101421
GROUP MEDICAID #
CA
01
—
HW7801A
GROUP MEDICARE #
CA
01
—
HW7801B
GROUP MEDICARE #
CA
01
—
LAB28654F
GROUP MEDICAID #
CA
01
—
W7801B
GROUP MEDICARE #
CA
01
—
ZZZ31029Z
GROUP BLUE SHIELD #
CA
01
—
ZZZ54738Z
GROUP BLUE SHIELD #
CA
01
—
ZZZ94714Z
GROUP BLUE SHIELD #
CA
Enumeration date
02/23/2006
Last updated
12/11/2013
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