Provider Demographics
NPI:1104707082
Name:MILOVANOVIC, DANIELLE JANET
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JANET
Last Name:MILOVANOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 HOWITT RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-6224
Mailing Address - Country:US
Mailing Address - Phone:207-774-7111
Mailing Address - Fax:207-775-1985
Practice Address - Street 1:400 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1704
Practice Address - Country:US
Practice Address - Phone:207-114-7111
Practice Address - Fax:207-775-1985
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELPN13929207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty