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General NPI Number Information
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NPI Number | 1902472772
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Entity Type | Individual
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Provider Name | MILAN KRSTOVIC PT
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Gender | Male
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1659 W HUBBARD ST
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City | CHICAGO
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State | IL
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Zip | 60622-6352
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Country | US
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Telephone | 312-489-8579
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60618-8317
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Country | US
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Telephone | 732-320-3097
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025799
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 070.025799
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License Number State | IL
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