MEDICARE: DR. GUNNBJORG BERIT LAVOLL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036 052579	IL

General Provider Information

NPI Number	:	1598810152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUNNBJORG BERIT LAVOLL MD

Provider Business Mailing Address
First Line	:	3122 N. SHERIDAN RD. SUITE 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1708
Country	:	US
Telephone Number	:	312-988-7877
Fax Number	:	312-988-9215

Provider Business Practice Location Address
First Line	:	3122 N. SHERIDAN RD. SUITE 2B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1708
Country	:	US
Telephone Number	:	312-988-7877
Fax Number	:	312-988-9215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/21/2022

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