Provider Demographics
NPI:1710149224
Name:JAVED, MAHWESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHWESH
Middle Name:
Last Name:JAVED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:221 NORTH EAST GLEN OAK AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61613
Mailing Address - Country:US
Mailing Address - Phone:309-672-5522
Mailing Address - Fax:
Practice Address - Street 1:16615 S RTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2941
Practice Address - Country:US
Practice Address - Phone:815-436-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine