Healthcare Provider Details

I. General information

NPI: 1265532766
Provider Name (Legal Business Name): ALEKSANDAR KONDIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 WILEY RD 125
SCHAUMBURG IL
60173
US

IV. Provider business mailing address

1305 WILEY RD 125
SCHAUMBURG IL
60173
US

V. Phone/Fax

Practice location:
  • Phone: 847-240-5080
  • Fax: 847-240-1977
Mailing address:
  • Phone: 847-240-5080
  • Fax: 847-240-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number036116931
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: