Provider Demographics
NPI:1134186414
Name:JAVIER, MARLU P (MD)
Entity type:Individual
Prefix:
First Name:MARLU
Middle Name:P
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:237 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5456
Mailing Address - Country:US
Mailing Address - Phone:630-433-1849
Mailing Address - Fax:773-873-1043
Practice Address - Street 1:6307 S STEWART AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-962-4635
Practice Address - Fax:773-873-1043
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036052495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052495Medicaid