Provider Demographics
NPI:1891965646
Name:MARCO A JARAVA MD SC
Entity Type:Organization
Organization Name:MARCO A JARAVA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:JARAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-421-1701
Mailing Address - Street 1:848 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5147
Mailing Address - Country:US
Mailing Address - Phone:312-421-1701
Mailing Address - Fax:312-421-1702
Practice Address - Street 1:848 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5147
Practice Address - Country:US
Practice Address - Phone:312-421-1701
Practice Address - Fax:312-421-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL261730Medicare PIN