Healthcare Provider Details

I. General information

NPI: 1043535248
Provider Name (Legal Business Name): KID CARE DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 S CICERO AVE
CICERO IL
60804-2411
US

IV. Provider business mailing address

2254 S CICERO AVE
CICERO IL
60804-2411
US

V. Phone/Fax

Practice location:
  • Phone: 708-222-9170
  • Fax: 708-222-9173
Mailing address:
  • Phone: 773-222-9170
  • Fax: 708-222-9173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL PETERS
Title or Position: CFO
Credential:
Phone: 312-274-0498