Individual
MRS. JOANNE SIM BAVELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
676 N SAINT CLAIR ST, 19TH FLOOR, CHICAGO, IL 60611-2927
(312) 926-3205
(312) 695-0042
Mailing address
777 N MICHIGAN AVE, APT 2301, CHICAGO, IL 60611-2617
(850) 543-8906
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085001689
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
776530
MEDICARE GROUP NUMBER
IL
Enumeration date
09/08/2005
Last updated
12/29/2010
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