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Organization

MITTIE M DRAGOSLJVICH MD LLC

Active
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Organization

MITTIE M DRAGOSLJVICH MD LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MITTIE MATTHEW DRAGOSLJVICH M.D. (PHYSICIAN/MANAGER)
(580) 917-5392
Entity
Organization

Contact information

Practice address
545 BRANSON LANDING BLVD STE 101, BRANSON, MO 65616-4055
(417) 348-8032
Mailing address
PO BOX 1071, BRANSON, MO 65615-1071
(580) 917-5392

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2008011533
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100025090A
OK
01
731377294001
BC/BS OF OKLAHOMA
OK
Enumeration date
07/05/2011
Last updated
07/05/2011
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