Healthcare Provider Details

I. General information

NPI: 1407853534
Provider Name (Legal Business Name): ASSOCIATED PEDIATRICS OF FOX VALLEY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 RIDGE AVE STE 101
AURORA IL
60504-4273
US

IV. Provider business mailing address

2121 RIDGE AVE STE 101
AURORA IL
60504-7001
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-7100
  • Fax: 630-264-2524
Mailing address:
  • Phone: 630-820-7100
  • Fax: 630-264-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD42-617396
License Number StateIL

VIII. Authorized Official

Name: MRS. DIANE M CROFT
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-952-2057