Healthcare Provider Details

I. General information

NPI: 1740367424
Provider Name (Legal Business Name): DRAGIC M OBRADOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 NORTH SHERIDAN ROAD #500
CHICAGO IL
60657-6156
US

IV. Provider business mailing address

2800 NORTH SHERIDAN ROAD #500
CHICAGO IL
60657-6156
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-0700
  • Fax: 773-348-1235
Mailing address:
  • Phone: 773-348-0700
  • Fax: 773-348-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36044631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: