Provider Demographics
NPI:1679686745
Name:PAVLOVICH, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:PAVLOVICH
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:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-1624
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:6294 STATE HIGHWAY 154
Practice Address - Street 2:
Practice Address - City:SESSER
Practice Address - State:IL
Practice Address - Zip Code:62884
Practice Address - Country:US
Practice Address - Phone:618-625-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL324148OtherGHP
IL370007818OtherRR MEDICARE NUMBER
IL3932056OtherBCBS OF IL
IL48175OtherGHP INSURANCE NUMBER
IL027538OtherHAMP INSURANCE NUMBER
IL036089862Medicaid
IL271458OtherHEALTHLINK
IL7210895OtherAETNA
IL3932056OtherBCBS OF IL
IL271458OtherHEALTHLINK
ILK45853Medicare PIN
ILE14114Medicare UPIN
IL370007818OtherRR MEDICARE NUMBER