Provider Demographics
NPI:1659631844
Name:JOSIP PASIC MD SC
Entity Type:Organization
Organization Name:JOSIP PASIC MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PASIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-728-6805
Mailing Address - Street 1:5510 N SHERIDAN RD
Mailing Address - Street 2:APT. 7A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1633
Mailing Address - Country:US
Mailing Address - Phone:773-728-6805
Mailing Address - Fax:
Practice Address - Street 1:5510 N SHERIDAN RD
Practice Address - Street 2:APT. 7A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1633
Practice Address - Country:US
Practice Address - Phone:773-728-6805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360506212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050621Medicaid
ILIL6976001Medicare PIN