Provider Demographics
NPI:1235492372
Name:DURAKOVIC, NEDIM (MD)
Entity type:Individual
Prefix:DR
First Name:NEDIM
Middle Name:
Last Name:DURAKOVIC
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NORTH NEW BALLAS RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-453-0001
Mailing Address - Fax:314-273-6674
Practice Address - Street 1:450 NORTH NEW BALLAS RD.
Practice Address - Street 2:SUITE 140
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-453-0001
Practice Address - Fax:314-273-6674
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017008331207Y00000X, 207YX0901X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200062118Medicaid