Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 239577 | MA |
NPI | 1053544106 |
---|---|
Provider Name | Dr. Marica Zizic Mitrecic |
First Address | Boston, MA 02114-3096 |
Second Address | Boston, MA 02114-3096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2009 |
Last Update Date | 24/08/2009 |