Healthcare Provider Details

I. General information

NPI: 1356043640
Provider Name (Legal Business Name): JULIA ORGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE, BUILDING 105 SUITE 1940
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S 1ST AVE, BUILDING 105 SUITE 1940
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-6200
  • Fax: 708-216-6840
Mailing address:
  • Phone: 708-216-6200
  • Fax: 708-216-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125.081236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: