Provider Demographics
NPI:1497308787
Name:RADOVIC MEDICAL, SC
Entity type:Organization
Organization Name:RADOVIC MEDICAL, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-504-6404
Mailing Address - Street 1:2515 WAUKEGAN RD # 100
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1569
Mailing Address - Country:US
Mailing Address - Phone:312-504-6404
Mailing Address - Fax:
Practice Address - Street 1:2515 WAUKEGAN RD # 100
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1569
Practice Address - Country:US
Practice Address - Phone:312-504-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty