MEDICARE: DR. ALEKSANDAR RADOVIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	01073147-A	IN
2	207P00000X	Emergency Medicine Physician	036136623	IL
3	208M00000X	Hospitalist Physician	036136623	IL
4	207Q00000X	Family Medicine Physician	261QU0200X	IL

General Provider Information

NPI Number	:	1053619676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEKSANDAR RADOVIC MD

Provider Business Mailing Address
First Line	:	680 N. LAKE SHORE DRIVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2987
Country	:	US
Telephone Number	:	312-695-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1082
Country	:	US
Telephone Number	:	847-873-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2011
Last Update Date	:	01/17/2025

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