MEDICARE: MS. ALEKSANDRA IVANOVIC 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	207R00000X	Internal Medicine Physician	036-110292	IL

General Provider Information

NPI Number	:	1477546711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEKSANDRA IVANOVIC MD

Provider Business Mailing Address
First Line	:	928 W SUNNYSIDE AVE
Second Line	:	APARTMENT 1E
City	:	CHICAGO
State	:	IL
Zip	:	60640-6023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 N MARINE DR
Second Line	:	SUITE 6100C
City	:	CHICAGO
State	:	IL
Zip	:	60640-5719
Country	:	US
Telephone Number	:	773-769-4411
Fax Number	:	773-769-5140

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/09/2007

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