Provider Demographics
NPI:1942292107
Name:TREVIL, JOSETTE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSETTE
Middle Name:M
Last Name:TREVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 E. SOUTH WATER ST
Mailing Address - Street 2:SUITE 1712
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4128
Mailing Address - Country:US
Mailing Address - Phone:312-861-3827
Mailing Address - Fax:312-861-3827
Practice Address - Street 1:360 E SOUTH WATER ST
Practice Address - Street 2:SUITE 1712
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4028
Practice Address - Country:US
Practice Address - Phone:312-861-3827
Practice Address - Fax:312-861-3827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-066595208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-066595-4Medicaid
ILD15193Medicare UPIN
ILK08231/209384Medicare ID - Type Unspecified