DEJAN MAKSIMOVIC (NPI# 1891992269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891992269 |
| Entity Type | Individual |
| Full Name | DEJAN MAKSIMOVIC |
| Credential | DO |
| Practice Address |
5114 N Glen Park Place Rd Peoria IL 61614-4686 |
| Practice Telephone | 3096552431 |
| Practice Fax Number | 3096832412 |
| Mailing Telephone | 3096552431 |
| Mailing Fax Number | 3096832412 |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2014-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036124188 | IL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 56981 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE INDIVIDUAL PTAN | 809840038 | 01 |
| IL | MEDICARE GROUP PTAN | 809840 | 01 |
| Street Address |
5114 N GLEN PARK PLACE RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477533057 | Susan Sphar | Midwife | 5114 N Glen Park Place Rd, Suite 220, Peoria, IL 61614-4686 | 2006-01-19 |
| 1851876593 | Grace Marie Harmon | Physician Assistant | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-09-28 |
| 1053801191 | Joy L Meachum | Social Worker | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-05-15 |
| 1932607835 | Ashley L Whitlatch | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2018-01-25 |
| 1417461260 | Michele D. Dudley | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-11-30 |
| 1639681117 | Melissa Renee Garmon | Physician Assistant | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-10-24 |
| 1104335546 | Lindsey Spangler | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-09-28 |
| 1295259901 | Laine K Thies | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-08-03 |
| 1083147763 | Jennifer Robison | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2017-04-10 |
| 1295280303 | Heidi L Gendron | Nurse Practitioner | 5114 N Glen Park Place Rd, Peoria, IL 61614-4686 | 2016-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1922621739 | Titan Medical LLC | Family Medicine | 13660 N 94th Dr Ste D-3, Peoria, AZ 85381-4836 | 2020-05-27 |
| 1619516788 | Michelle Martin | Family Medicine | 15182 N 75th Ave # Uint180, Peoria, AZ 85381-4722 | 2020-01-06 |
| 1124667555 | District Medical Group, Inc | Family Medicine | 15182 N 75th Ave Ste 180, Peoria, AZ 85381-4722 | 2020-01-02 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1992236848 | Agape Primary Care, Pllc | Family Medicine | 8380 W Emile Zola Ave # 5178, Peoria, AZ 85381-4811 | 2017-03-22 |
| 1043666910 | Honorhealth Medical Group, LLC | Family Medicine | 10230 W Happy Valley Rd, Ste100, Peoria, AZ 85383-2795 | 2016-05-10 |
| 1598160863 | Healthcare Partners Arizona Medical Group LLC | Family Medicine | 16155 N 83rd Ave Ofc, #201, Peoria, AZ 85382-5815 | 2014-10-29 |
| 1164856506 | Charlotte Christie Clayton | Family Medicine | 7505 N Edgewild Dr, Peoria, IL 61614-2117 | 2013-08-21 |
| 1770824112 | Dean Robert Bordeaux | Family Medicine | 7614 N Patton Ln, Peoria, IL 61614-1828 | 2013-03-11 |
| 1467731935 | James Austin Shane Jr. | Family Medicine | 18821 N 94th Ave, Peoria, AZ 85382-3697 | 2011-08-15 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.