Healthcare Provider Details

I. General information

NPI: 1164491858
Provider Name (Legal Business Name): ELIZABETH J LAVOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST GALTER PAV 11-230
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

PO BOX 249
WILMETTE IL
60091-0249
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-6868
  • Fax:
Mailing address:
  • Phone: 847-676-0091
  • Fax: 847-676-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: