Healthcare Provider Details

I. General information

NPI: 1750875407
Provider Name (Legal Business Name): VALENTINA DJORDJEVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 06/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W DIVERSEY PKWY
CHICAGO IL
60614-6068
US

IV. Provider business mailing address

561 W DIVERSEY PKWY
CHICAGO IL
60614-6068
US

V. Phone/Fax

Practice location:
  • Phone: 773-906-4546
  • Fax: 773-304-4549
Mailing address:
  • Phone: 773-906-4546
  • Fax: 773-304-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: