Basic Information
| Provider Information | |||||||||
| NPI: | 1366585366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAVIER | ||||||||
| FirstName: | CALVIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2153 | ||||||||
| Address2: | |||||||||
| City: | BEDFORD PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604992153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003541088 | ||||||||
| FaxNumber: | 3146314672 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 W 68TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606291813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738849000 | ||||||||
| FaxNumber: | 3146314672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 036117152 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.