MEDICARE: ZOFIA T STEVANOVIC 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
1	174400000X	Specialist	036-054838	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21609632	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437231644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOFIA T STEVANOVIC M.D.

Provider Business Mailing Address
First Line	:	6058 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2610
Country	:	US
Telephone Number	:	773-736-2772
Fax Number	:	773-736-9122

Provider Business Practice Location Address
First Line	:	3208 N MAJOR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4332
Country	:	US
Telephone Number	:	773-736-2772
Fax Number	:	773-736-9122

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	09/12/2016

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