Provider Demographics
NPI:1144220864
Name:GAVRILOVICI, ANA D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:D
Last Name:GAVRILOVICI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3411
Mailing Address - Country:US
Mailing Address - Phone:847-568-1500
Mailing Address - Fax:847-568-1511
Practice Address - Street 1:6400 N KEATING AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3411
Practice Address - Country:US
Practice Address - Phone:847-568-1500
Practice Address - Fax:847-568-1511
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-099746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099746Medicaid
ILH11432Medicare UPIN
IL036099746Medicaid