Provider Demographics
NPI:1336254820
Name:BULATOVIC, VUKSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VUKSAN
Middle Name:
Last Name:BULATOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5200 N. ROCKWELL STREET
Mailing Address - Street 2:1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3334
Mailing Address - Country:US
Mailing Address - Phone:773-983-0811
Mailing Address - Fax:773-582-1380
Practice Address - Street 1:5200 N. ROCKWELL STREET
Practice Address - Street 2:1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3334
Practice Address - Country:US
Practice Address - Phone:773-983-0811
Practice Address - Fax:773-582-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI16748207R00000X
IL036-094166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG10082Medicare UPIN