Healthcare Provider Details

I. General information

NPI: 1669454658
Provider Name (Legal Business Name): ZIVOJIN PAVLOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N LINCOLN AVE STE 183
LINCOLNWOOD IL
60712-1736
US

IV. Provider business mailing address

7301 N LINCOLN AVE STE 183
LINCOLNWOOD IL
60712-1736
US

V. Phone/Fax

Practice location:
  • Phone: 224-766-7669
  • Fax: 847-674-0892
Mailing address:
  • Phone: 224-766-7669
  • Fax: 847-674-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036061976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: