Healthcare Provider Details

I. General information

NPI: 1144481847
Provider Name (Legal Business Name): EMILY A LOVAASEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

14 LAKE ST PCC LAKE STREET FAMILY HEALTH CENTER
OAK PARK IL
60302-2606
US

V. Phone/Fax

Practice location:
  • Phone: 773-378-3347
  • Fax: 708-383-9911
Mailing address:
  • Phone: 708-383-0113
  • Fax: 708-383-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125054997
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036127718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: