Basic Information
| Provider Information | |||||||||
| NPI: | 1003006701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GVOZDJAN | ||||||||
| FirstName: | DRAGOSLAV | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10S641 S GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605276317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034156502 | ||||||||
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| Practice Location | |||||||||
| Address1: | 415 N 26TH ST STE 103 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479042855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654466400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2007 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 01069714A | IN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.