Provider Demographics
NPI:1245317940
Name:LAZAREVIC, VOJISLAV (MD)
Entity type:Individual
Prefix:
First Name:VOJISLAV
Middle Name:
Last Name:LAZAREVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NORTH SHERIDAN ROAD
Mailing Address - Street 2:# 500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-348-0700
Mailing Address - Fax:773-348-1235
Practice Address - Street 1:2800 NORTH SHERIDAN ROAD
Practice Address - Street 2:# 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-348-0700
Practice Address - Fax:773-348-0148
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36094624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36094624Medicaid
IL1621001OtherBCBS
IL1621001OtherBCBS
ILG60897Medicare UPIN