Healthcare Provider Details

I. General information

NPI: 1801811757
Provider Name (Legal Business Name): SALUD PEDIATRICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S RANDALL RD SUITE 220
ALGONQUIN IL
60102-5935
US

IV. Provider business mailing address

600 S RANDALL RD SUITE 220
ALGONQUIN IL
60102-5935
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-9402
  • Fax: 847-854-9403
Mailing address:
  • Phone: 847-854-9402
  • Fax: 847-854-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036101829
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier05632081
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name: JOANNA E. BETANCOURT
Title or Position: DIRECTOR
Credential: M.D.
Phone: 847-854-9402