Organization
FOX VALLEY NEUROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE R GAVINO MD (PRESIDENT)
(847) 695-8721
Entity
Organization
Contact information
Practice address
860 SUMMIT ST, STE 254, ELGIN, IL 60120-4339
(847) 695-8721
(847) 695-8755
Mailing address
860 SUMMIT ST, STE 254, ELGIN, IL 60120-4339
(847) 695-8721
(847) 695-8755
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
060000735
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615763
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/10/2006
Last updated
11/30/2012
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