Individual
MICHAEL LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 PENNSYLVANIA AVE, GLEN ELLYN, IL 60137-4464
(630) 469-9200
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036063940
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063940
—
IL
Enumeration date
02/28/2006
Last updated
10/02/2019
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