Provider Demographics
NPI:1386104826
Name:MATIJEVICH, DANIELA (DPM,MS)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:
Last Name:MATIJEVICH
Suffix:
Gender:F
Credentials:DPM,MS
Other - Prefix:DR
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:LAZAREVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM,MS
Mailing Address - Street 1:330 W HOUGHTON DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-0015
Mailing Address - Country:US
Mailing Address - Phone:219-577-2288
Mailing Address - Fax:
Practice Address - Street 1:601 GATEWAY BLVD N
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9658
Practice Address - Country:US
Practice Address - Phone:219-921-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001398A213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine