MEDICARE: MR. NENAD MITROVIC M.AC LIC.AC DN LMT

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	171100000X	Acupuncturist	198000475	IL

General Provider Information

NPI Number	:	1609087212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NENAD MITROVIC M.AC LIC.AC DN LMT

Provider Business Mailing Address
First Line	:	3950 N LAKE SHORE DR
Second Line	:	1220-D
City	:	CHICAGO
State	:	IL
Zip	:	60613-3434
Country	:	US
Telephone Number	:	312-287-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 N LAKE SHORE DR
Second Line	:	1220-D
City	:	CHICAGO
State	:	IL
Zip	:	60613-3434
Country	:	US
Telephone Number	:	312-287-4864
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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