Provider Demographics
NPI:1164605036
Name:UZELAC, BILJANA (MD)
Entity Type:Individual
Prefix:
First Name:BILJANA
Middle Name:
Last Name:UZELAC
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:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1153
Mailing Address - Country:US
Mailing Address - Phone:219-232-2772
Mailing Address - Fax:219-232-2802
Practice Address - Street 1:8247 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8878
Practice Address - Country:US
Practice Address - Phone:219-232-2772
Practice Address - Fax:219-232-2802
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064437208000000X
IN01064437A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200912140Medicaid
IN01064437AOtherLICENSE