MEDICARE: JASMINKA KOSTIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036104292	IL
2	207Q00000X	Family Medicine Physician	036104292	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073599775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINKA KOSTIC MD

Provider Business Mailing Address
First Line	:	3114 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3406
Country	:	US
Telephone Number	:	773-588-6680
Fax Number	:	773-588-6451

Provider Business Practice Location Address
First Line	:	3114 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3406
Country	:	US
Telephone Number	:	773-588-6680
Fax Number	:	773-588-6451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	02/28/2017

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