Organization
ADVANCED DERMATOLOGIC & COSMETIC INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRDJAN PRODANOVICH MD (OWNER)
(239) 598-3200
Entity
Organization
Contact information
Practice address
90 CYPRESS WAY E, SUITE 50, NAPLES, FL 34110-9275
(239) 598-3200
(239) 598-0233
Mailing address
90 CYPRESS WAY E, SUITE 50, NAPLES, FL 34110-9275
(239) 598-3200
(239) 598-0233
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME95851
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG2330
MEDICARE RAILROAD
FL
Enumeration date
05/26/2006
Last updated
11/10/2015
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