| Organization Name: | NIKOLA IVANCEVIC DPM PC |
| NPI Number: | 1013191287 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NIKOLA IVANCEVIC (PODIATRIST) |
| Mailing Address: | 135 S Palmer Dr Suite 105 Elmhurst |
| State: | IL US |
| Postal Code: | 601263403 |
| Phone Number: | 6307826557 |
| Fax Number: | 6307826559 |
| NPI Enumeration Date: | 12/24/2007 |
| NPI Last Update Date: | 04/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 016-004831 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |