Provider Demographics
NPI:1871540377
Name:PRODANOVICH, SRDJAN (MD)
Entity type:Individual
Prefix:
First Name:SRDJAN
Middle Name:
Last Name:PRODANOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CYPRESS WAY E
Mailing Address - Street 2:SUITE 50
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:239-598-3200
Mailing Address - Fax:239-598-0233
Practice Address - Street 1:90 CYPRESS WAY E
Practice Address - Street 2:SUITE 50
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:239-598-3200
Practice Address - Fax:239-598-0233
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95851207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00423914OtherMEDICARE RAILROAD
7613852OtherAETNA
FL276398200Medicaid
FL53224OtherBCBS
FL53224OtherBCBS
7613852OtherAETNA