Provider Demographics
NPI:1043663610
Name:MILICEVIC, SLAVKO (DPT)
Entity Type:Individual
Prefix:
First Name:SLAVKO
Middle Name:
Last Name:MILICEVIC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6715
Mailing Address - Country:US
Mailing Address - Phone:630-447-9746
Mailing Address - Fax:630-385-0124
Practice Address - Street 1:1942 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6715
Practice Address - Country:US
Practice Address - Phone:630-447-9746
Practice Address - Fax:630-385-0124
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist