Healthcare Provider Details

I. General information

NPI: 1194865287
Provider Name (Legal Business Name): PEDIATRIC HEALTH PARTNERS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

IV. Provider business mailing address

10436 SOUTHWEST HWY
CHICAGO RIDGE IL
60415-2282
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-0700
  • Fax: 708-636-3849
Mailing address:
  • Phone: 708-636-0700
  • Fax: 708-636-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY ANN COLLINS
Title or Position: M.D.
Credential: M.D.
Phone: 708-636-0700