Provider Demographics
NPI:1215946603
Name:MAVASHEV, FELIKS S (MD)
Entity type:Individual
Prefix:DR
First Name:FELIKS
Middle Name:S
Last Name:MAVASHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3748
Mailing Address - Country:US
Mailing Address - Phone:773-271-1500
Mailing Address - Fax:773-271-2048
Practice Address - Street 1:1007 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5017
Practice Address - Country:US
Practice Address - Phone:773-271-1500
Practice Address - Fax:773-271-2048
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01626490OtherBCBSIL
IL036101294OtherIL LICENSE
IL036101294Medicaid
IL036101294OtherIL LICENSE
ILK01991Medicare PIN
IL207489Medicare PIN