Provider Demographics
NPI:1063557569
Name:MARIA SLOBODIAN MD SC
Entity type:Organization
Organization Name:MARIA SLOBODIAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:AP
Authorized Official - Last Name:SLOBODIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-848-5410
Mailing Address - Street 1:1 ERIE CT
Mailing Address - Street 2:SUITE#7040
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2566
Mailing Address - Country:US
Mailing Address - Phone:708-848-5410
Mailing Address - Fax:708-848-6539
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE#7040
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-848-5410
Practice Address - Fax:708-848-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634435OtherBCBS PROVIDER ID
ILDB9675OtherRAILROAD MEDICARE
IL1634435OtherBCBS PROVIDER ID
ILDB9675Medicare PIN