Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | 036062416 | IL |
Y | 207W00000X | Ophthalmologist | 036062416 | IL |
NPI | 1285794362 |
---|---|
Provider Name | Dr. Tatjana K Pavlovic |
First Address | Chicago, IL 60659-3919 |
Second Address | Chicago, IL 60659-3919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 15/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036062416 | (05) | IL |
363313307 | COMMERCIAL (01) | IL |
722020 | FORCE MATCH (01) | |
D15372 | (02) | IL |