Healthcare Provider Details

I. General information

NPI: 1356205538
Provider Name (Legal Business Name): CHICAGO DEVELOPMENTAL & BEHAVIORAL PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 W IRVING PARK RD
CHICAGO IL
60618-3923
US

IV. Provider business mailing address

4132 N BELL AVE
CHICAGO IL
60618-2914
US

V. Phone/Fax

Practice location:
  • Phone: 773-636-6975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARIN VANDER PLOEG BOOTH
Title or Position: OWNER
Credential: MD
Phone: 773-636-6975