Healthcare Provider Details

I. General information

NPI: 1033596309
Provider Name (Legal Business Name): VIDA PEDIATRICS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 W 59TH ST
CHICAGO IL
60629-2504
US

IV. Provider business mailing address

3124 W 59TH ST
CHICAGO IL
60629-2504
US

V. Phone/Fax

Practice location:
  • Phone: 773-906-5160
  • Fax: 773-498-7415
Mailing address:
  • Phone: 773-906-5160
  • Fax: 773-498-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALEJANDRO CLAVIER
Title or Position: PRESIDENT
Credential: MD, MPH
Phone: 773-906-5160