Healthcare Provider Details

I. General information

NPI: 1962419937
Provider Name (Legal Business Name): ALL STAR PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 JOLIET RD
COUNTRYSIDE IL
60525-4642
US

IV. Provider business mailing address

6410 JOLIET RD
COUNTRYSIDE IL
60525-4642
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-4448
  • Fax: 708-352-1052
Mailing address:
  • Phone: 708-352-4448
  • Fax: 708-352-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DONNA RUGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-352-4448