Provider Demographics
NPI:1811383573
Name:MARKOVIC, IRENA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:
Last Name:MARKOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENA
Other - Middle Name:
Other - Last Name:ZIVKOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1316 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6724
Mailing Address - Country:US
Mailing Address - Phone:630-461-0822
Mailing Address - Fax:
Practice Address - Street 1:1045 W STEPHENSON ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032
Practice Address - Country:US
Practice Address - Phone:815-599-6389
Practice Address - Fax:815-599-6949
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.147306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program