Provider Demographics
NPI:1164494183
Name:TKALCEVIC, NEDA ZERGOLLERN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEDA
Middle Name:ZERGOLLERN
Last Name:TKALCEVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MILLBURNE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-295-7620
Mailing Address - Fax:847-295-7619
Practice Address - Street 1:30 TOWER CT STE C
Practice Address - Street 2:GREENLEAF CENTER
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3322
Practice Address - Country:US
Practice Address - Phone:847-559-0715
Practice Address - Fax:847-599-0766
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050674207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
04900707OtherBLUE SHIELD
IL477590Medicare ID - Type Unspecified
04900707OtherBLUE SHIELD