MEDICARE: DR. ANA D GAVRILOVICI M.D.

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	207Q00000X	Family Medicine Physician	036-099746	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144220864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANA D GAVRILOVICI M.D.

Provider Business Mailing Address
First Line	:	6400 N KEATING AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3411
Country	:	US
Telephone Number	:	847-568-1500
Fax Number	:	847-568-1511

Provider Business Practice Location Address
First Line	:	6400 N KEATING AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3411
Country	:	US
Telephone Number	:	847-568-1500
Fax Number	:	847-568-1511

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	09/26/2012

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