MEDICARE: CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC

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	2080P0006X	Developmental - Behavioral Pediatrics Physician

General Provider Information

NPI Number	:	1356205538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	4132 N BELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3923
Country	:	US
Telephone Number	:	773-636-6975
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARIN VANDER PLOEG BOOTH
Credential	:	MD
Telephone Number	:	773-636-6975

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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