Provider Demographics
NPI:1851519888
Name:B JERCINOVIC PEDIATRICS LTD
Entity Type:Organization
Organization Name:B JERCINOVIC PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:J
Authorized Official - Last Name:JERCINOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-729-1144
Mailing Address - Street 1:807 W JEFFERSON ST UNIT Q
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-7301
Mailing Address - Country:US
Mailing Address - Phone:815-729-1144
Mailing Address - Fax:815-729-1157
Practice Address - Street 1:807 W JEFFERSON ST UNIT Q
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-7301
Practice Address - Country:US
Practice Address - Phone:815-729-1144
Practice Address - Fax:815-729-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care