Provider Demographics
NPI:1609908698
Name:KOVACEVIC, MIROSLAV (MD)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:
Last Name:KOVACEVIC
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 1:333 CHESTNUT ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3247
Mailing Address - Country:US
Mailing Address - Phone:630-986-1010
Mailing Address - Fax:630-986-1015
Practice Address - Street 1:333 CHESTNUT ST
Practice Address - Street 2:SUITE #103
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3247
Practice Address - Country:US
Practice Address - Phone:630-986-1010
Practice Address - Fax:630-986-1015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD10220Medicare UPIN