Provider Demographics
NPI:1033202262
Name:SCAVONE, DEAN J (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:J
Last Name:SCAVONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-7742
Practice Address - Street 1:2300 N. VERMILION AVENUE
Practice Address - Street 2:MEDICAL SUB-SPECIALTIES
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-554-1800
Practice Address - Fax:217-444-5888
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036107286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860016Medicare NSC
ILIL3270283Medicare PIN
G58798Medicare UPIN
ILG58798Medicare UPIN