Healthcare Provider Details

I. General information

NPI: 1295293306
Provider Name (Legal Business Name): KRASTINA GADJEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 SOUTH MARTIN LUTHER KING DRIVE
CHICAGO IL
60616
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-7828
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-7117
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018908
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: