Healthcare Provider Details

I. General information

NPI: 1356305965
Provider Name (Legal Business Name): STEVEN MILENKOVIC PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 NEW ST
BLUE ISLAND IL
60406-2402
US

IV. Provider business mailing address

19001 OLD LAGRANGE RD
MOKENA IL
60448-8012
US

V. Phone/Fax

Practice location:
  • Phone: 708-824-1114
  • Fax: 708-824-9341
Mailing address:
  • Phone: 708-478-3600
  • Fax: 708-478-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: