Provider Demographics
NPI:1851466932
Name:THOMAS A PAVLOVIC MD SC
Entity Type:Organization
Organization Name:THOMAS A PAVLOVIC MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-696-1200
Mailing Address - Street 1:1875 DEMPSTER ST
Mailing Address - Street 2:#604
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1186
Mailing Address - Country:US
Mailing Address - Phone:847-696-1200
Mailing Address - Fax:847-696-1203
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:#604
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-696-1200
Practice Address - Fax:847-696-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036041714207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4901064OtherBCBS
IL036041714Medicaid
IL036041714Medicaid
ILC42432Medicare UPIN