Provider Demographics
NPI:1003006701
Name:GVOZDJAN, DRAGOSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:DRAGOSLAV
Middle Name:
Last Name:GVOZDJAN
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 1:10S641 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6317
Mailing Address - Country:US
Mailing Address - Phone:703-415-6502
Mailing Address - Fax:
Practice Address - Street 1:415 N 26TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2855
Practice Address - Country:US
Practice Address - Phone:765-446-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069714A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry