MEDICARE: DR. FELIKS S MAVASHEV 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	207R00000X	Internal Medicine Physician	036101294	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01626490	OTHER		BCBSIL
2	036101294	OTHER	IL	IL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215946603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELIKS S MAVASHEV MD

Provider Business Mailing Address
First Line	:	994 COVENTRY LN
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3748
Country	:	US
Telephone Number	:	773-271-1500
Fax Number	:	773-271-2048

Provider Business Practice Location Address
First Line	:	1007 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-271-1500
Fax Number	:	773-271-2048

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/13/2020

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