Provider Demographics
NPI:1700589942
Name:BOZOVICH, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BOZOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 RED TAIL CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-6415
Mailing Address - Country:US
Mailing Address - Phone:347-838-1653
Mailing Address - Fax:
Practice Address - Street 1:3001 N. GREEN BAY RD
Practice Address - Street 2:BLDG 133EF 1F-204
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:224-610-7707
Practice Address - Fax:224-610-7703
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041347312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse