Provider Demographics
NPI:1528354842
Name:CAVALLO, ALLISON BROOKE
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:BROOKE
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ALLISON
Other - Middle Name:BROOKE
Other - Last Name:CAVALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1206 E 9TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-2404
Practice Address - Country:US
Practice Address - Phone:630-545-7524
Practice Address - Fax:630-351-2425
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059284207ZP0102X
IL036137167207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137167Medicaid