Healthcare Provider Details

I. General information

NPI: 1366815250
Provider Name (Legal Business Name): WINDY CITY PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 825
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

3000 N HALSTED SUITE 825
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1075
  • Fax: 708-424-1715
Mailing address:
  • Phone: 773-880-1075
  • Fax: 708-424-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number49012
License Number StateMN

VIII. Authorized Official

Name: DR. AYMAN RAWDA
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 773-880-1075