MEDICARE: SAMULIO CVETKOVIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1679422000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMULIO CVETKOVIC PLLC

Provider Business Mailing Address
First Line	:	1821 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4044
Country	:	US
Telephone Number	:	773-526-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4044
Country	:	US
Telephone Number	:	773-526-9830
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	SAMUILO CVETKOVIC
Credential	:	DDS
Telephone Number	:	773-526-9830

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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