Provider Demographics
NPI:1538259494
Name:PAVEGLIO, JILL M (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:PAVEGLIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2794
Mailing Address - Fax:989-583-2811
Practice Address - Street 1:3875 BAY RD
Practice Address - Street 2:SUITE 2N
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2417
Practice Address - Country:US
Practice Address - Phone:989-583-5300
Practice Address - Fax:989-583-5325
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301084288OtherSTATE LICENSE
MI1538259494Medicaid
MI1538259494Medicaid