Healthcare Provider Details

I. General information

NPI: 1265440663
Provider Name (Legal Business Name): PEDIATRICS AND CHILD DEVELOPMENT CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 W ALGONQUIN RD SUITE A
ALGONQUIN IL
60102-9403
US

IV. Provider business mailing address

2575 W ALGONQUIN RD SUITE A
ALGONQUIN IL
60102-9403
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-4574
  • Fax: 847-587-6113
Mailing address:
  • Phone: 847-658-4574
  • Fax: 847-587-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number036092453
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number036092453
License Number StateIL

VIII. Authorized Official

Name: MUSSARAT ARSHAD
Title or Position: OWNER
Credential: MD
Phone: 847-658-4574