Healthcare Provider Details

I. General information

NPI: 1164605036
Provider Name (Legal Business Name): BILJANA UZELAC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8247 WICKER AVE
SAINT JOHN IN
46373-8878
US

IV. Provider business mailing address

PO BOX 1153
CROWN POINT IN
46308-1153
US

V. Phone/Fax

Practice location:
  • Phone: 219-232-2772
  • Fax: 219-232-2802
Mailing address:
  • Phone: 219-232-2772
  • Fax: 219-232-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064437
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01064437A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: