Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036-086293 | IL |
NPI | 1033278577 |
---|---|
Provider Name | Zoran Milan Grujic |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036086293 | (05) | IL |
206147 | MEDICARE PTAN (GROUP) (01) | |
2061470463 | MEDICARE PTAN (INDIVIDUAL) (01) | |
CA4748 | MEDICARE RAILROAD (GROUP) (01) | |
F94950 | (02) | IL |
P00904917 | MEDICARE RAILROAD (GROUP) (01) |