Provider Demographics
NPI:1184345530
Name:KONDIC, ADILA
Entity type:Individual
Prefix:
First Name:ADILA
Middle Name:
Last Name:KONDIC
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 1:272 S WESTMINISTER CT
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-8149
Mailing Address - Country:US
Mailing Address - Phone:224-578-0415
Mailing Address - Fax:
Practice Address - Street 1:272 S WESTMINISTER CT
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-8149
Practice Address - Country:US
Practice Address - Phone:224-578-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program