Individual
DR. SLOBODAN D VUCICEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3501 S HARLEM AVE, BERWYN, IL 60402-3263
(708) 749-0117
(708) 749-8593
Mailing address
3501 HARLEM AVE, BERWYN, IL 60402-3263
(708) 749-0117
(708) 749-8593
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036055452
IL
Other
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
Enumeration date
08/10/2005
Last updated
06/21/2011
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