Provider Demographics
NPI:1326192428
Name:PAVONE, MARY ELLEN (MD, MSCI)
Entity Type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:PAVONE
Suffix:
Gender:F
Credentials:MD, MSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2915
Mailing Address - Country:US
Mailing Address - Phone:312-695-7269
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 2400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-695-7269
Practice Address - Fax:312-695-4924
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP18023207V00000X
IL036118744207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology