MEDICARE: JOSEPH M. PAVESE 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	207V00000X	Obstetrics & Gynecology Physician	036062600	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
2	0479220001	OTHER	IL	DMERC

General Provider Information

NPI Number	:	1588747620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH M. PAVESE M.D.

Provider Business Mailing Address
First Line	:	4225 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2623
Country	:	US
Telephone Number	:	708-423-2300
Fax Number	:	708-423-2318

Provider Business Practice Location Address
First Line	:	4225 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2623
Country	:	US
Telephone Number	:	708-423-2300
Fax Number	:	708-423-2318

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	06/17/2008

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