Provider Demographics
NPI:1114902632
Name:MILENKOVICH, DANICA (MD)
Entity Type:Individual
Prefix:MS
First Name:DANICA
Middle Name:
Last Name:MILENKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:47 W POLK ST STE G1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2083
Practice Address - Country:US
Practice Address - Phone:312-922-3011
Practice Address - Fax:312-922-5860
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084845A207R00000X, 208M00000X
IL036092363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092363Medicaid
IL01621679OtherBCBS OF IL
IN300043509Medicaid