Healthcare Provider Details

I. General information

NPI: 1437105947
Provider Name (Legal Business Name): PEDIATRICS & DERMATOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 N MILWAUKEE AVE
CHICAGO IL
60646-3730
US

IV. Provider business mailing address

6211 N MILWAUKEE AVE
CHICAGO IL
60646-3730
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-6677
  • Fax: 773-774-3322
Mailing address:
  • Phone: 773-774-6677
  • Fax: 773-774-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MIROSLAWA ALINA DULCZEWSKA MILLER
Title or Position: CEO
Credential: MD PHD
Phone: 773-774-6677