Doctor Name: | MIRSEN LEKOVIC |
NPI Number: | 1811285174 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 4301099452 |
Business Practice Address: | 451 Health Pkwy Suite B Paw Paw, MI - 490798242 |
Business Phone Number: | 2696553065 |
Business Fax Number: | 2696550588 |
Mailing Address: | 451 Health Pkwy, Suite B PAW PAW |
State: | MI |
Postal Code: | 490798242 |
Phone Number: | 2696553065 |
Fax Number: | 2696550588 |
NPI Enumeration Date: | 07/20/2011 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301099452 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |