Individual
DR. GORAN MICEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,PHD
Contact information
Practice address
20 YORK ST DEPT OF DERMATOLOGY, NEW HAVEN, CT 06510-3220
(203) 688-4242
Mailing address
333 CEDAR STREET, DEPT. OF DERMATOLOGY, LC1 501 PO BOX 208059, NEW HAVEN, CT 06520-8059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
70721
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2018
Last updated
04/30/2022
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