Provider Demographics
NPI:1104159896
Name:ILIC BOGOJEVIC, ZVEZDANA (MD)
Entity type:Individual
Prefix:
First Name:ZVEZDANA
Middle Name:
Last Name:ILIC BOGOJEVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZVEZDANA
Other - Middle Name:
Other - Last Name:ILIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:508 BONNIE BRAE PL
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1945
Mailing Address - Country:US
Mailing Address - Phone:708-771-4179
Mailing Address - Fax:
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:STE 101
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1673
Practice Address - Country:US
Practice Address - Phone:630-646-6200
Practice Address - Fax:630-428-4188
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine