Provider Demographics
NPI:1821048778
Name:ENDOCRINE & DIABETES ASSOCIATES S C
Entity Type:Organization
Organization Name:ENDOCRINE & DIABETES ASSOCIATES S C
Other - Org Name:SANIJA BAJRAMOVIC, M.D., S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJRAMOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-340-6677
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-340-6677
Mailing Address - Fax:312-873-1105
Practice Address - Street 1:30 N MICHIGAN AVE STE 1108
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-340-6677
Practice Address - Fax:312-873-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086681207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01622667OtherBLUE SHIELD
IL036086681Medicaid
IL460003291OtherRAILROAD MEDICARE
IL01622667OtherBLUE SHIELD
G46384Medicare UPIN