Healthcare Provider Details

I. General information

NPI: 1609804129
Provider Name (Legal Business Name): PEDIATRIC CENTER OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W WEBSTER STE 306
CHICAGO IL
60614
US

IV. Provider business mailing address

550 W WEBSTER STE 306
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-3549
  • Fax: 773-883-3550
Mailing address:
  • Phone: 773-883-3549
  • Fax: 773-883-3550

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. HOWARD B LEVY
Title or Position: PRESIDENT
Credential: MD
Phone: 773-883-3957