Organization
NIKOLA IVANCEVIC DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKOLA IVANCEVIC DPM (PODIATRIST)
(630) 782-6557
Entity
Organization
Contact information
Practice address
135 S PALMER DR, SUITE 105, ELMHURST, IL 60126-3403
(630) 782-6557
(630) 782-6559
Mailing address
1630 VICTORIA AVE, BERKELEY, IL 60163-1467
(630) 782-6557
(630) 782-6559
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
016-004831
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016-004831
—
IL
01
—
480027618
MEDICARE RAILROAD PIN
IL
Enumeration date
12/24/2007
Last updated
04/22/2008
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