Provider Demographics
NPI:1801433925
Name:DIDOVIC, INES
Entity type:Individual
Prefix:
First Name:INES
Middle Name:
Last Name:DIDOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E RANDOLPH ST APT 3721
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5065
Mailing Address - Country:US
Mailing Address - Phone:708-307-5653
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 117
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4448
Practice Address - Country:US
Practice Address - Phone:312-288-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021959363LF0000X
IL041.438142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse