Healthcare Provider Details

I. General information

NPI: 1801433925
Provider Name (Legal Business Name): INES DIDOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 117
CHICAGO IL
60611-4448
US

IV. Provider business mailing address

400 E RANDOLPH ST APT 3721
CHICAGO IL
60601-5065
US

V. Phone/Fax

Practice location:
  • Phone: 312-288-6420
  • Fax:
Mailing address:
  • Phone: 708-307-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021959
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.438142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: