Healthcare Provider Details

I. General information

NPI: 1780729145
Provider Name (Legal Business Name): NORTH SUBURBAN PEDIATRICS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 RIDGE AVE SUITE 201
EVANSTON IL
60201-2492
US

IV. Provider business mailing address

2530 RIDGE AVE SUITE 201
EVANSTON IL
60201-2492
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-0892
  • Fax: 847-869-1070
Mailing address:
  • Phone: 847-869-0892
  • Fax: 847-869-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS KELLY A KIRSCHBAUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-869-6485