Healthcare Provider Details

I. General information

NPI: 1457912628
Provider Name (Legal Business Name): MISS EMINA DJELOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 RIDGE AVE
EVANSTON IL
60201-2492
US

IV. Provider business mailing address

950 LEE ST STE 210
DES PLAINES IL
60016-6574
US

V. Phone/Fax

Practice location:
  • Phone: 866-815-6592
  • Fax: 847-486-4145
Mailing address:
  • Phone: 866-815-6592
  • Fax: 847-486-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.012873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: