MEDICARE: ILIE PAVEL PC

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	122300000X	Dentist	019-023032	IL

General Provider Information

NPI Number	:	1760643639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILIE PAVEL PC

Provider Business Mailing Address
First Line	:	6122 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2314
Country	:	US
Telephone Number	:	773-739-2800
Fax Number	:	773-739-2520

Provider Business Practice Location Address
First Line	:	6122 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2314
Country	:	US
Telephone Number	:	773-739-2800
Fax Number	:	773-739-2520

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ILIE P. PAVEL
Credential	:	D.D.S.
Telephone Number	:	773-739-2800

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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Directions to “ILIE PAVEL PC ” Practice Location

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