Provider Demographics
NPI:1033315338
Name:JASMINKA KOSTIC, M.D.,S.C.
Entity Type:Organization
Organization Name:JASMINKA KOSTIC, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-588-6680
Mailing Address - Street 1:3114 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3406
Mailing Address - Country:US
Mailing Address - Phone:773-588-6680
Mailing Address - Fax:773-588-6451
Practice Address - Street 1:3114 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3406
Practice Address - Country:US
Practice Address - Phone:773-588-6680
Practice Address - Fax:773-588-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11309Medicare ID - Type Unspecified
ILH39100Medicare UPIN
IL210125Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER