Provider Demographics
NPI:1225190309
Name:BULATOVIC, SRDJA (MD)
Entity Type:Individual
Prefix:DR
First Name:SRDJA
Middle Name:
Last Name:BULATOVIC
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 1:1770 1ST ST
Mailing Address - Street 2:SUITE 703
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-433-1539
Mailing Address - Fax:847-433-1552
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:SUITE 703
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-433-1539
Practice Address - Fax:847-433-1552
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044136207L00000X
IL036107996207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8435265Medicaid
WAI35168Medicare UPIN