Provider Demographics
NPI:1700986817
Name:DRAGAN IVKOVIC MD SC
Entity Type:Organization
Organization Name:DRAGAN IVKOVIC MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IVKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-681-7332
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 508
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-681-7332
Mailing Address - Fax:708-681-7698
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 508
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7332
Practice Address - Fax:708-681-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-054830207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-054830Medicaid
C45482Medicare UPIN
992440Medicare ID - Type Unspecified