Provider Demographics
NPI:1730246067
Name:BAJMAKOVIC-KACILA, SENADA (MD)
Entity type:Individual
Prefix:
First Name:SENADA
Middle Name:
Last Name:BAJMAKOVIC-KACILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3706
Mailing Address - Country:US
Mailing Address - Phone:312-942-5375
Mailing Address - Fax:
Practice Address - Street 1:2150 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3706
Practice Address - Country:US
Practice Address - Phone:312-942-5375
Practice Address - Fax:312-942-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2063812084P0800X
IL036-1365762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01810140Medicaid
NY01810140Medicaid
NY02612Medicare ID - Type Unspecified