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General NPI Number Information
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NPI Number | 1417159377
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Entity Type | Individual
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Provider Name | GORAN TUBIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/07/2019
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Provider Practice Location Address
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Address Line | 420 S. SCHMIDT ROAD STE. 110
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1737
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Country | US
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Telephone | 630-312-4562
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Fax | 630-312-6651
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Provider Business Mailing Address
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Address Line | 420 REMINGTON BLVD SUITE 240
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4925
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Country | US
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Telephone | 630-312-4505
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Fax | 630-312-6868
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036115600
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 036115600
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License Number State | IL
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