Healthcare Provider Details

I. General information

NPI: 1578612438
Provider Name (Legal Business Name): CHILDRENS MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 47TH ST
CHICAGO IL
60609-3872
US

IV. Provider business mailing address

1801 W 47TH ST
CHICAGO IL
60609-3872
US

V. Phone/Fax

Practice location:
  • Phone: 773-847-9004
  • Fax: 773-847-9008
Mailing address:
  • Phone: 773-847-9004
  • Fax: 773-847-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. NADA AL DALLAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-847-9004