Individual
PATRICIA MAUREEN GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-2696
(708) 783-5096
Mailing address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-2696
(708) 783-5096
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01057193A
IN
2085R0202X
Diagnostic Radiology Physician
88544
OH
2085R0202X
Diagnostic Radiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065903 1
—
IL
01
—
P00057215
RR MEDICARE
IL
Enumeration date
05/26/2006
Last updated
02/14/2008
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