Healthcare Provider Details

I. General information

NPI: 1508516139
Provider Name (Legal Business Name): JAVIER HERNANDEZ JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

1540 E MEDICAL CENTER DR
ANN ARBOR MI
48109-0100
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-2000
  • Fax:
Mailing address:
  • Phone: 734-615-7845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101029040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: