Provider Demographics
NPI:1508023078
Name:CHORVAT, KEVIN TODD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:TODD
Last Name:CHORVAT
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 1:1325 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1449
Mailing Address - Country:US
Mailing Address - Phone:630-801-2635
Mailing Address - Fax:630-801-2685
Practice Address - Street 1:1325 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1449
Practice Address - Country:US
Practice Address - Phone:630-801-2635
Practice Address - Fax:630-801-2685
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117520207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R02626Medicare PIN