Provider Demographics
NPI:1801153002
Name:TOVAREK, GEORGE STANLEY
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:STANLEY
Last Name:TOVAREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:STANLEY
Other - Last Name:TOVAREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:520 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6715
Mailing Address - Country:US
Mailing Address - Phone:630-858-3876
Mailing Address - Fax:
Practice Address - Street 1:520 RAINTREE DR
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6715
Practice Address - Country:US
Practice Address - Phone:630-858-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL036.036753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist