Provider Demographics
NPI:1326123530
Name:GAVRAN, MONICA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:E
Last Name:GAVRAN
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 1:1925 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-9301
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-428-7425
Practice Address - Street 1:1925 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-9301
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-428-7425
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101601 2Medicaid
IL036101601 2Medicaid
H23297Medicare UPIN