Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 125063816 | IL |
Y | 208800000X | Urologist | 35.139169 | OH |
NPI | 1053653501 |
---|---|
Provider Name | Petar Bajic |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 15/09/2021 |