Provider Demographics
NPI:1386644037
Name:GOVOSTIS, DEAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:MICHAEL
Last Name:GOVOSTIS
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 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:10258 SOUTHWEST HWY STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1361
Practice Address - Country:US
Practice Address - Phone:708-346-9533
Practice Address - Fax:708-499-4312
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043535A2086S0129X
WI26979-202086S0129X
IL0360827872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082787Medicaid
IN200123460BMedicaid
IL036082787Medicaid
IL950701Medicare PIN
IN200123460BMedicaid
IL060017059Medicare PIN
IL060017053Medicare PIN