Healthcare Provider Details

I. General information

NPI: 1629310073
Provider Name (Legal Business Name): JELENA KOVACEVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE MERCY HOSPITAL AND MEDICAL CENTER
CHICAGO IL
60616
US

IV. Provider business mailing address

1524 S SANGAMON ST UNIT 508
CHICAGO IL
60608-2267
US

V. Phone/Fax

Practice location:
  • Phone: 754-242-2727
  • Fax:
Mailing address:
  • Phone: 754-242-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036140234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: