Provider Demographics
NPI:1770528481
Name:PAVIC, SANDRA VERA (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VERA
Last Name:PAVIC
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6439 WEST 63RD STREET
Mailing Address - Street 2:APT 1C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4148
Mailing Address - Country:US
Mailing Address - Phone:773-572-4083
Mailing Address - Fax:
Practice Address - Street 1:6439 WEST 63RD STREET
Practice Address - Street 2:APT 1C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-4148
Practice Address - Country:US
Practice Address - Phone:773-572-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001622511OtherBCBS
IL0001622511OtherBCBS
IL497610Medicare ID - Type Unspecified