Healthcare Provider Details

I. General information

NPI: 1710168299
Provider Name (Legal Business Name): PRECIOUS HEARTS PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 E OAKTON ST
DES PLAINES IL
60018-2120
US

IV. Provider business mailing address

1595 E OAKTON ST
DES PLAINES IL
60018-2120
US

V. Phone/Fax

Practice location:
  • Phone: 847-375-0707
  • Fax: 847-375-0808
Mailing address:
  • Phone: 847-375-0707
  • Fax: 847-375-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036087868
License Number StateIL

VIII. Authorized Official

Name: DR. ELIZABETH D MANJOORAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-375-0707