MEDICARE: PEDIATRIC ASSOCIATES SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036037561	IL

General Provider Information

NPI Number	:	1043498041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ASSOCIATES SC

Provider Business Mailing Address
First Line	:	2011 EAST 75TH STREET
Second Line	:	SUITE 101
City	:	CHICAGO
State	:	IL
Zip	:	60649-3646
Country	:	US
Telephone Number	:	773-288-4824
Fax Number	:	773-288-3995

Provider Business Practice Location Address
First Line	:	2011 EAST 75TH STREET
Second Line	:	SUITE 101
City	:	CHICAGO
State	:	IL
Zip	:	60649-3646
Country	:	US
Telephone Number	:	773-288-4824
Fax Number	:	773-288-3995

Authorized Official
Title or Position	:	PRIMARY CARE PHYSICIAN
Name	:	MRS. BILLIE WRIGHT ADAMS
Credential	:	MD
Telephone Number	:	773-288-4824

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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