Provider Demographics
NPI:1689951709
Name:BIELIC, DANA ELENA
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:ELENA
Last Name:BIELIC
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 1:2099 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9331
Mailing Address - Country:US
Mailing Address - Phone:708-341-8717
Mailing Address - Fax:
Practice Address - Street 1:1003 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2712
Practice Address - Country:US
Practice Address - Phone:219-663-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051030964183500000X
IN26022259A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist