MEDICARE: DR. LUCIO A. PAVONE 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	2086S0122X	Plastic and Reconstructive Surgery Physician	A98219	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	036123223	IL

General Provider Information

NPI Number	:	1790966844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIO A. PAVONE M.D.

Provider Business Mailing Address
First Line	:	120 SPALDING DR STE 207
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6520
Country	:	US
Telephone Number	:	630-646-6020
Fax Number	:	630-646-6006

Provider Business Practice Location Address
First Line	:	120 SPALDING DR STE 207
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6520
Country	:	US
Telephone Number	:	630-646-6020
Fax Number	:	630-646-6006

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	03/15/2021

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