Individual
DR. TATJANA K PAVLOVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2719 W PETERSON AVE, CHICAGO, IL 60659-3919
(773) 271-2719
(773) 271-9994
Mailing address
2719 W PETERSON AVE, CHICAGO, IL 60659-3919
(773) 271-2719
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
036062416
IL
207W00000X
Ophthalmology Physician
Primary
036062416
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062416
—
IL
01
—
363313307
COMMERCIAL
IL
01
—
722020
FORCE MATCH
—
Enumeration date
12/11/2006
Last updated
06/15/2020
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