Individual
DINA PAVILONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
965 LAKE ST, OAK PARK, IL 60301-1292
(708) 383-0400
Mailing address
965 LAKE ST, ATTN: TRACY BRIONES, OAK PARK, IL 60301-1292
(708) 383-0400
(708) 383-4314
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036131456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125058764
LICENSE
IL
Enumeration date
08/13/2010
Last updated
06/16/2014
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