Provider Demographics
NPI:1356043640
Name:ORGAN, JULIA (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ORGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE, BUILDING 105
Mailing Address - Street 2:SUITE 1940
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-6200
Mailing Address - Fax:708-216-6840
Practice Address - Street 1:2160 S 1ST AVE, BUILDING 105
Practice Address - Street 2:SUITE 1940
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-6200
Practice Address - Fax:708-216-6840
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.0812362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program