Provider Demographics
NPI:1194730861
Name:OSMANOVIC, SMAJO S (MD)
Entity type:Individual
Prefix:
First Name:SMAJO
Middle Name:S
Last Name:OSMANOVIC
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 1:1604 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2407
Mailing Address - Country:US
Mailing Address - Phone:847-394-1414
Mailing Address - Fax:847-418-8928
Practice Address - Street 1:1604 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2407
Practice Address - Country:US
Practice Address - Phone:847-394-1414
Practice Address - Fax:847-394-5380
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097049207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632914OtherBC/BS
IL180045934OtherRAILROAD MEDICARE
IL036097049Medicaid
IL4709660001Medicare NSC
01632914OtherBC/BS
203921Medicare ID - Type Unspecified