Provider Demographics
NPI:1205998192
Name:VUCICEVIC, DUSAN (MD)
Entity type:Individual
Prefix:
First Name:DUSAN
Middle Name:
Last Name:VUCICEVIC
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 1:6856 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6967
Mailing Address - Country:US
Mailing Address - Phone:630-258-2073
Mailing Address - Fax:630-325-8445
Practice Address - Street 1:6856 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6967
Practice Address - Country:US
Practice Address - Phone:630-258-2073
Practice Address - Fax:630-325-8445
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18820207L00000X
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09774Medicare UPIN