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NPI Code Detail

MEDICARE: DR. VLADIMIR VIDANOVIC M.D.

MEDICARE: DR. VLADIMIR VIDANOVIC M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician036114637IL
2207ZH0000XHematology (Pathology) Physician36114637IL
3207ZC0500XCytopathology Physician036114637IL

General Provider Information

NPI Number : 1366459562
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VLADIMIR VIDANOVIC M.D.
Provider Business Mailing Address
First Line : 200 W ADAMS ST STE 225
Second Line :
City : CHICAGO
State : IL
Zip : 60606-5212
Country : US
Telephone Number : 312-704-2885
Fax Number : 312-704-2737
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE # EMS2280
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-327-2689
Fax Number : 312-704-2737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 01/23/2026

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