Individual
JOSEPH M CIVANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
71 W 156TH ST, SUITE 400, HARVEY, IL 60426-4265
(708) 596-8710
(708) 596-9820
Mailing address
11516 183RD PL STE SW, ORLAND PARK, IL 60467-9471
(708) 877-1300
(708) 596-8719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036086038
IL
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
036086038
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086038
—
IL
01
—
180015438
RRMC
IL
01
—
180030696
RRMC
IL
Enumeration date
07/22/2005
Last updated
02/04/2022
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