Healthcare Provider Details

I. General information

NPI: 1780724898
Provider Name (Legal Business Name): CHICAGO PEDIATRIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 W IRVING PARK RD
CHICAGO IL
60613-2408
US

IV. Provider business mailing address

777 OAKMONT LN SUITE 1600
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 773-477-4900
  • Fax: 773-477-4478
Mailing address:
  • Phone: 630-789-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DARLENE EGUES
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 773-477-4900