Provider Demographics
NPI:1427360916
Name:TOMISLAV DUKIC MD SC
Entity Type:Organization
Organization Name:TOMISLAV DUKIC MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TOMISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-725-2322
Mailing Address - Street 1:5958 WEST LAWRENCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3130
Mailing Address - Country:US
Mailing Address - Phone:773-725-2322
Mailing Address - Fax:773-725-2322
Practice Address - Street 1:5958 WEST LAWRENCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3130
Practice Address - Country:US
Practice Address - Phone:773-725-2322
Practice Address - Fax:773-725-2322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOMISLAV DUKIC, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-13
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03604894G207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048946Medicaid
IL477170Medicare PIN
IL036048946Medicaid