Provider Demographics
NPI:1528050218
Name:PREVATT, GREGORY T (O,T,SC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:PREVATT
Suffix:
Gender:M
Credentials:O,T,SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 GUNDERSEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2402
Mailing Address - Country:US
Mailing Address - Phone:630-665-9155
Mailing Address - Fax:630-665-5557
Practice Address - Street 1:327 GUNDERSEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2402
Practice Address - Country:US
Practice Address - Phone:630-665-9155
Practice Address - Fax:630-665-5557
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other