Provider Demographics
NPI:1144730235
Name:MUSTAFAYEV, JAVIDAN SR
Entity type:Individual
Prefix:MR
First Name:JAVIDAN
Middle Name:
Last Name:MUSTAFAYEV
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 W CATHERINE AVE UNIT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2500
Mailing Address - Country:US
Mailing Address - Phone:312-951-3191
Mailing Address - Fax:
Practice Address - Street 1:8528 W CATHERINE AVE UNIT 3S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2500
Practice Address - Country:US
Practice Address - Phone:312-951-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)