Most Relevant Information
Provider Data
| NPI Number: | 1003551979 |
| Provider Name: | MILICA IVANOV NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 71012485A |
Most Important Dates
| Enumeration Date: | 05/04/2022 |
| Last Updated: | 05/04/2022 |
Provider Practice Location
1532 CALUMET AVE
DYER
IN
463111588
Practice Location Phone/Fax
| Phone: | 2195154700 |
| Fax: |
Provider Mailing Location
10110 DONALD S POWERS DR
SUITE 101D
MUNSTER
IN
46321
Provider Mailing Phone/Fax
| Phone: | 2193017264 |
| Fax: |