Healthcare Provider Details

I. General information

NPI: 1740308196
Provider Name (Legal Business Name): TOWN AND COUNTRY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

IV. Provider business mailing address

1460 N HALSTED ST STE 402
CHICAGO IL
60642-2607
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-8900
  • Fax: 312-981-6312
Mailing address:
  • Phone: 312-279-8900
  • Fax: 312-981-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD42002840
License Number StateIL

VIII. Authorized Official

Name: MS. NIL TUNCA
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-279-8900