Healthcare Provider Details

I. General information

NPI: 1821038274
Provider Name (Legal Business Name): KIJANA SEFEROVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 N LINCOLN AVE
CHICAGO IL
60625-3113
US

IV. Provider business mailing address

5106 N LINCOLN AVE
CHICAGO IL
60625-3113
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-8255
  • Fax: 773-907-8296
Mailing address:
  • Phone: 773-907-8255
  • Fax: 773-907-8296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036113528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: