Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | P18023 | MD |
Y | 207VE0102X | Reproductive Endocrinologist | 036118744 | IL |
NPI | 1326192428 |
---|---|
Provider Name | Dr. Mary Ellen Pavone |
First Address | Chicago, IL 60611-2915 |
Second Address | Chicago, IL 60611-3907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 13/06/2019 |