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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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