# DR. SLOBODAN D VUCICEVIC

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1720089824
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036055452 | IL | Yes |

## Other

- **Enumeration date:** 08/10/2005
- **Last updated:** 06/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036055452 | — | IL |
| 01 | — | 2221384 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | 363203419 | TAX IDENTIFICATION | IL |
| 01 | — | 672600 | MEDICARE ID TYPE UNSPECIF | IL |