Provider Demographics
NPI:1588747620
Name:PAVESE, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:PAVESE
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 1:4225 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2623
Mailing Address - Country:US
Mailing Address - Phone:708-423-2300
Mailing Address - Fax:708-423-2318
Practice Address - Street 1:4225 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2623
Practice Address - Country:US
Practice Address - Phone:708-423-2300
Practice Address - Fax:708-423-2318
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062600Medicaid
IL0479220001OtherDMERC
IL0479220001OtherDMERC
ILD15422Medicare UPIN