Provider Demographics
NPI:1407083447
Name:JAVETTE C ORGAIN MD SC
Entity Type:Organization
Organization Name:JAVETTE C ORGAIN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORGAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-833-1077
Mailing Address - Street 1:PO BOX 806527
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4126
Mailing Address - Country:US
Mailing Address - Phone:312-833-1077
Mailing Address - Fax:877-825-1491
Practice Address - Street 1:9933 S WESTERN AVE
Practice Address - Street 2:EMB - SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1810
Practice Address - Country:US
Practice Address - Phone:312-833-1077
Practice Address - Fax:877-825-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty