Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036081992 | IL |
NPI | 1023099744 |
---|---|
Provider Name | Dr. Alexander James Javois |
First Address | Willow Brook, IL 60527-5343 |
Second Address | Oak Lawn, IL 60453-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 24/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036081992 | (05) | IL |
1617609 | BC/BS (01) | IL |
20029130 | INDYPA MEDICAID (01) | IN |
F82294 | (02) |