Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016004743 | IL |
Y | 222Z00000X | Podiatrist | 016004743 | IL |
N | 213EP0504X | Public Medicine | 016004743 | IL |
N | 213EP1101X | Primary Podiatric Medicine | 016004743 | IL |
N | 111NR0200X | Radiology | 016004743 | IL |
N | 213ER0200X | Radiology | 016004743 | IL |
N | 2081S0010X | Sports Medicine | 016004743 | IL |
N | 213ES0000X | Sports Medicine | 016004743 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016004743 | IL |
NPI | 1861424624 |
---|---|
Provider Name | Dr. Kevin Sean Gavin |
First Address | Algonquin, IL 60102-2741 |
Second Address | Algonquin, IL 60102-2741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 04/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01606879 | BLUE CROSS BLUE SHIELD (01) | IL |
480023961 | RAILROAD MEDICARE (01) | IL |
5090108 | AETNA (01) | IL |
U57810 | (02) | IL |