Provider Demographics
NPI:1235258849
Name:PASIC, JOSIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSIP
Middle Name:
Last Name:PASIC
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 1:5510 N. SHERIDAN ROAD
Mailing Address - Street 2:#7A
Mailing Address - City:CHICAOG
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-728-6805
Mailing Address - Fax:773-293-3907
Practice Address - Street 1:5510 N. SHERIDAN ROAD
Practice Address - Street 2:#7A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-728-6805
Practice Address - Fax:773-293-3907
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0506212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050621Medicaid
IL036050621OtherLISCENSE NUMBER
ILD13758Medicare UPIN
IL036050621Medicaid