Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 8702756-1252 | UT |
N | 207RH0003X | Hematology & Oncology | 8702756-1252 | UT |
NPI | 1417384694 |
---|---|
Provider Name | Djordje Atanackovic |
First Address | Hamburg, HAMBURG 22299 |
Second Address | Salt Lake City, UT 84132-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2013 |
Last Update Date | 02/10/2013 |