1104159896 NPI number — ZVEZDANA ILIC BOGOJEVIC M.D.

Table of content: ZVEZDANA ILIC BOGOJEVIC M.D. (NPI 1104159896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104159896 NPI number — ZVEZDANA ILIC BOGOJEVIC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILIC BOGOJEVIC
Provider First Name:
ZVEZDANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ILIC
Provider Other First Name:
ZVEZDANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104159896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 BONNIE BRAE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-1945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-771-4179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3033 OGDEN AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-646-6200
Provider Business Practice Location Address Fax Number:
630-428-4188
Provider Enumeration Date:
09/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036128650 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)