Healthcare Provider Details

I. General information

NPI: 1134186414
Provider Name (Legal Business Name): MARLU P JAVIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 S STEWART AVE SUITE 311
CHICAGO IL
60621-3116
US

IV. Provider business mailing address

237 WATERFORD DR
WILLOW BROOK IL
60527-5456
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-4635
  • Fax: 773-873-1043
Mailing address:
  • Phone: 630-433-1849
  • Fax: 773-873-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036052495
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: