Provider Demographics
NPI:1871511196
Name:HLAVACEK, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:HLAVACEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:HLAVACEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1050
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:630-725-2783
Practice Address - Street 1:2 MID AMERICA PLZ
Practice Address - Street 2:SUIE 720
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4451
Practice Address - Country:US
Practice Address - Phone:630-571-0055
Practice Address - Fax:630-571-1335
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060125207V00000X
IL036060125208D00000X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL789510OtherGROUP MEDICARE PTAN
IL789511OtherGROUP MEDICARE PTAN
IL036060125Medicaid
IL36060125OtherLICENSE
P00930OtherINDIVIDUAL MEDICARE #
IL789511003Medicare PIN
ILDC4196Medicare PIN
P00930OtherINDIVIDUAL MEDICARE #
IL36060125OtherLICENSE
IL789510003Medicare PIN