Provider Demographics
NPI:1053409706
Name:DUKIC, TOMISLAV (MD)
Entity type:Individual
Prefix:
First Name:TOMISLAV
Middle Name:
Last Name:DUKIC
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5958 W LAWRENCE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3130
Mailing Address - Country:US
Mailing Address - Phone:773-725-2322
Mailing Address - Fax:773-725-2322
Practice Address - Street 1:5958 W LAWRENCE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3130
Practice Address - Country:US
Practice Address - Phone:773-725-2322
Practice Address - Fax:773-725-2322
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021624775OtherBCBS
D12733Medicare UPIN
IL0021624775OtherBCBS