Provider Demographics
NPI:1083661086
Name:BRANOVACKI, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BRANOVACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMITTANCE DRIVE
Mailing Address - Street 2:SUITE 6581
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6581
Mailing Address - Country:US
Mailing Address - Phone:708-226-3300
Mailing Address - Fax:708-226-4202
Practice Address - Street 1:10719 WEST 160TH STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5541
Practice Address - Country:US
Practice Address - Phone:708-226-3300
Practice Address - Fax:708-226-4202
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109227207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109227OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER
IL250013909OtherRAILROAD MEDICARE PROVIDER NUMBER
ILI06620Medicare UPIN
IL1032380001Medicare NSC