Organization
CONCHITA G GAVINO MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONCHITA G GAVINO MD (PRESIDENT)
(847) 695-8721
Entity
Organization
Contact information
Practice address
860 SUMMIT ST, SUITE 254, ELGIN, IL 60120-4339
(847) 695-8721
(847) 695-8755
Mailing address
860 SUMMIT ST, SUITE 254, ELGIN, IL 60120-4339
(847) 695-8721
(847) 695-8755
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
042005671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021609243
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/10/2006
Last updated
11/30/2012
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