Provider Demographics
NPI:1528084779
Name:CAVENS, PAULA (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CAVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 W 47TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-3011
Mailing Address - Country:US
Mailing Address - Phone:773-254-6044
Mailing Address - Fax:773-254-6115
Practice Address - Street 1:3229 W 47TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3011
Practice Address - Country:US
Practice Address - Phone:773-254-6044
Practice Address - Fax:773-254-6115
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098850Medicaid
H27263Medicare UPIN
IL036098850Medicaid
367830Medicare PIN