Provider Demographics
NPI:1407963630
Name:JALOVEC, LYNNE MARIE (MD)
Entity type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MARIE
Last Name:JALOVEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:STE 310
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5015
Mailing Address - Country:US
Mailing Address - Phone:309-672-4174
Mailing Address - Fax:309-672-4132
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-672-4174
Practice Address - Fax:309-672-4132
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068613-3Medicaid
020041463OtherRR MEDICARE
07222457OtherBCBS
IL036068613-3Medicaid
D86533Medicare UPIN