Provider Demographics
NPI:1790966844
Name:PAVONE, LUCIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIO
Middle Name:A
Last Name:PAVONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 SPALDING DR STE 207
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6520
Mailing Address - Country:US
Mailing Address - Phone:630-646-6020
Mailing Address - Fax:630-646-6006
Practice Address - Street 1:120 SPALDING DR STE 207
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6520
Practice Address - Country:US
Practice Address - Phone:630-646-6020
Practice Address - Fax:630-646-6006
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA982192086S0122X
IL0361232232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery