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General NPI Number Information
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NPI Number | 1366459562
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Entity Type | Individual
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Provider Name | VLADIMIR VIDANOVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE # EMS2280
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-327-2689
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Fax | 312-704-2737
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Provider Business Mailing Address
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Address Line | 200 W ADAMS ST SUITE 225
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City | CHICAGO
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State | IL
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Zip | 60606-5212
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Country | US
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Telephone | 312-704-2885
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Fax | 312-704-2737
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 36114637
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036114637
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License Number State | IL
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