Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD-44204 | IA |
Y | 2080P0202X | Pediatric Cardiologist | MD-44204 | IA |
NPI | 1053739888 |
---|---|
Provider Name | Nikola Dragisic |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2014 |
Last Update Date | 21/08/2020 |