=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033315338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASMINKA KOSTIC, M.D.,S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3114 W IRVING PARK RD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-588-6680
-----------------------------------------------------
Fax | 773-588-6451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3114 W IRVING PARK RD
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60618-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-588-6680
-----------------------------------------------------
Fax | 773-588-6451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MISS KATHY MILANOVIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-588-6680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------