MEDICARE: JAVETTE C ORGAIN MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1407083447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAVETTE C ORGAIN MD SC

Provider Business Mailing Address
First Line	:	PO BOX 806527
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-4126
Country	:	US
Telephone Number	:	312-833-1077
Fax Number	:	877-825-1491

Provider Business Practice Location Address
First Line	:	9933 S WESTERN AVE
Second Line	:	EMB - SUITE 103
City	:	CHICAGO
State	:	IL
Zip	:	60643-1810
Country	:	US
Telephone Number	:	312-833-1077
Fax Number	:	877-825-1491

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. JAVETTE C ORGAIN
Credential	:	MD
Telephone Number	:	312-833-1077

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	10/25/2013

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