Provider Demographics
NPI:1992705230
Name:DJUKIC, SERGE (MD)
Entity type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:DJUKIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRDJAN
Other - Middle Name:
Other - Last Name:DJUKIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2401 ORANGEBURG AVE, STE 675
Mailing Address - Street 2:PMB 246
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3379
Mailing Address - Country:US
Mailing Address - Phone:209-222-7342
Mailing Address - Fax:
Practice Address - Street 1:2401 ORANGEBURG AVE, STE 675
Practice Address - Street 2:PMB 246
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3379
Practice Address - Country:US
Practice Address - Phone:209-222-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA393892085R0202X
CAA510552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8270738Medicaid
G59165Medicare UPIN
WA8270738Medicaid