Provider Demographics
NPI:1356625875
Name:ZOFIA STEVANOVIC MD LTD
Entity Type:Organization
Organization Name:ZOFIA STEVANOVIC MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZOFIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:STEVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-736-2772
Mailing Address - Street 1:6058 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2610
Mailing Address - Country:US
Mailing Address - Phone:773-736-2772
Mailing Address - Fax:
Practice Address - Street 1:6058 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2610
Practice Address - Country:US
Practice Address - Phone:773-736-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054838261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054838Medicaid