Basic Information
| Provider Information | |||||||||
| NPI: | 1053619676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADOVIC | ||||||||
| FirstName: | ALEKSANDAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 N. LAKE SHORE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126956868 | ||||||||
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| Practice Location | |||||||||
| Address1: | 635 N DEARBORN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606544618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126942273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2011 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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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 | 207P00000X | 01073147-A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 036136623 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | 036136623 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.