Provider Demographics
NPI:1740367424
Name:OBRADOVIC, DRAGIC M (MD)
Entity type:Individual
Prefix:
First Name:DRAGIC
Middle Name:M
Last Name:OBRADOVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 NORTH SHERIDAN ROAD
Mailing Address - Street 2:#500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-348-0700
Mailing Address - Fax:773-348-1235
Practice Address - Street 1:2800 NORTH SHERIDAN ROAD
Practice Address - Street 2:#500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-348-0700
Practice Address - Fax:773-348-1235
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36044631207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36044631Medicaid
IL1621001OtherBCBS
IL1621001OtherBCBS
C41772Medicare UPIN