Healthcare Provider Details

I. General information

NPI: 1194551887
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF ARLINGTON HEIGHTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W CENTRAL RD STE 209
ARLINGTON HEIGHTS IL
60005-2453
US

IV. Provider business mailing address

1614 W CENTRAL RD STE 209
ARLINGTON HEIGHTS IL
60005-2453
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-5070
  • Fax: 847-259-5322
Mailing address:
  • Phone: 847-259-5070
  • Fax: 847-259-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIERA IANNANTUONI
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 847-259-5070