Healthcare Provider Details

I. General information

NPI: 1902472772
Provider Name (Legal Business Name): MILAN KRSTOVIC PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 W HUBBARD ST
CHICAGO IL
60622-6352
US

IV. Provider business mailing address

3022 N OAKLEY AVE
CHICAGO IL
60618-8317
US

V. Phone/Fax

Practice location:
  • Phone: 312-489-8579
  • Fax:
Mailing address:
  • Phone: 732-320-3097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.025799
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070.025799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: