Healthcare Provider Details

I. General information

NPI: 1699020800
Provider Name (Legal Business Name): EMA DZAKA-DIZDAREVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAINT JOSEPH HOSPITAL 2900 N. LAKESHORE DRIVE
CHICAGO IL
60657
US

IV. Provider business mailing address

SAINT JOSEPH HOSPITAL 2900 N. LAKESHORE DRIVE
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 773-665-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: