Provider Demographics
NPI:1669571170
Name:SAVIC, LYDIA (MD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:SAVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:SAVIC-DURNAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:534 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5076
Mailing Address - Country:US
Mailing Address - Phone:815-381-7005
Mailing Address - Fax:815-381-0776
Practice Address - Street 1:534 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5076
Practice Address - Country:US
Practice Address - Phone:815-381-7005
Practice Address - Fax:815-381-0776
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085529Medicaid
IL036085529Medicaid
ILF43783Medicare UPIN