=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285891713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARLU P. JAVIER, MD SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2008
-----------------------------------------------------
Last Update Date | 05/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6853 S HALSTED ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60621-1868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-723-7602
-----------------------------------------------------
Fax | 773-723-9298
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 WATERFORD DR
-----------------------------------------------------
City | WILLOWBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60527-5456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-723-7602
-----------------------------------------------------
Fax | 773-723-9298
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | MARLU P. JAVIER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 773-723-7602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------