Healthcare Provider Details

I. General information

NPI: 1679748503
Provider Name (Legal Business Name): CHICAGO PEDIATRIC & NEONATOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 561
CHICAGO IL
60631-3716
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 561
CHICAGO IL
60631-3716
US

V. Phone/Fax

Practice location:
  • Phone: 773-467-8866
  • Fax: 773-467-8886
Mailing address:
  • Phone: 773-467-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036079081
License Number StateIL

VIII. Authorized Official

Name: HALINA ANIOL
Title or Position: MD
Credential: MD
Phone: 773-467-8866