MEDICARE: SENADA BAJMAKOVIC-KACILA MD

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	2084P0800X	Psychiatry Physician	206381	NY
2	2084P0800X	Psychiatry Physician	036-136576	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730246067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SENADA BAJMAKOVIC-KACILA MD

Provider Business Mailing Address
First Line	:	2150 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-5375
Fax Number	:	312-942-3113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	12/03/2015

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