Provider Demographics
NPI:1235381906
Name:ALEKSANDAR KONDIC, INC
Entity Type:Organization
Organization Name:ALEKSANDAR KONDIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-855-5155
Mailing Address - Street 1:309 N OLTENDORF RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-6889
Mailing Address - Country:US
Mailing Address - Phone:630-855-5155
Mailing Address - Fax:630-855-5187
Practice Address - Street 1:309 N OLTENDORF RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-6889
Practice Address - Country:US
Practice Address - Phone:630-855-5155
Practice Address - Fax:630-855-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361169312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116931Medicaid
ILIL1289Medicare PIN
IL036116931Medicaid
ILIL1291Medicare PIN