Provider Demographics
NPI:1437231644
Name:STEVANOVIC, ZOFIA T (MD)
Entity Type:Individual
Prefix:
First Name:ZOFIA
Middle Name:T
Last Name:STEVANOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 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:773-736-9122
Practice Address - Street 1:3208 N MAJOR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4332
Practice Address - Country:US
Practice Address - Phone:773-736-2772
Practice Address - Fax:773-736-9122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-054838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609632OtherBCBS
IL036054838Medicaid
IL036054838Medicaid
IL654420Medicare ID - Type Unspecified