MEDICARE: BILJANA UZELAC 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	208000000X	Pediatrics Physician	01064437	IN
2	208000000X	Pediatrics Physician	01064437A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01064437A	OTHER	IN	LICENSE

General Provider Information

NPI Number	:	1164605036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILJANA UZELAC MD

Provider Business Mailing Address
First Line	:	PO BOX 1153
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46308-1153
Country	:	US
Telephone Number	:	219-232-2772
Fax Number	:	219-232-2802

Provider Business Practice Location Address
First Line	:	8247 WICKER AVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-8878
Country	:	US
Telephone Number	:	219-232-2772
Fax Number	:	219-232-2802

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	02/06/2017

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