Provider Demographics
NPI:1861658445
Name:SAMARDZIJA, MELANIE KOMAR (PHD, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:KOMAR
Last Name:SAMARDZIJA
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S. MARYLAND ST. MC 7120
Mailing Address - Street 2:UNIVERSITY OF CHICAGO MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:773-834-7108
Mailing Address - Fax:773-834-8816
Practice Address - Street 1:5841 S. MARYLAND ST. MC 7120
Practice Address - Street 2:UNIVERSITY OF CHICAGO MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:219-981-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001153A363L00000X
IL209.004210363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner