Healthcare Provider Details

I. General information

NPI: 1760247803
Provider Name (Legal Business Name): PARADIGM PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E WATERSIDE DR UNIT 3404
CHICAGO IL
60601-8015
US

IV. Provider business mailing address

420 E WATERSIDE DR UNIT 3404
CHICAGO IL
60601-8015
US

V. Phone/Fax

Practice location:
  • Phone: 872-225-0959
  • Fax:
Mailing address:
  • Phone: 872-225-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NOREDIA ALILE
Title or Position: MANAGER
Credential: MD
Phone: 872-225-0959