Provider Demographics
NPI:1861686388
Name:SLOBODAN D. VUCICEVIC,MD, SC
Entity Type:Organization
Organization Name:SLOBODAN D. VUCICEVIC,MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SLOBODAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VUCICEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-749-0117
Mailing Address - Street 1:3501 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3263
Mailing Address - Country:US
Mailing Address - Phone:708-749-0117
Mailing Address - Fax:708-749-8593
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:708-749-0117
Practice Address - Fax:708-749-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2221384OtherBLUE CROSS/BLUE SHIELD
IL=========OtherTAX ID #
ILC45745Medicare UPIN
IL2221384OtherBLUE CROSS/BLUE SHIELD