Provider Demographics
NPI:1730431776
Name:MARKOVIC, JASMINA (RD)
Entity type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:MARKOVIC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BUSSE HWY
Mailing Address - Street 2:P.O. BOX 533
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-7956
Mailing Address - Country:US
Mailing Address - Phone:847-208-1936
Mailing Address - Fax:
Practice Address - Street 1:3900 N LAKE SHORE DR
Practice Address - Street 2:2C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3452
Practice Address - Country:US
Practice Address - Phone:847-208-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004339133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered