Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-109227 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036-109227 | IL |
NPI | 1083661086 |
---|---|
Provider Name | Dr. George Branovacki |
First Address | Orland Park, IL 60675-6581 |
Second Address | Orland Park, IL 60467-5541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036109227 | BLUE CROSS BLUE SHIELD PROVIDER NUMBER (01) | IL |
250013909 | RAILROAD MEDICARE PROVIDER NUMBER (01) | IL |
I06620 | (02) | IL |