Healthcare Provider Details

I. General information

NPI: 1548337793
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3749 W 95TH ST
EVERGREEN PARK IL
60805-2019
US

IV. Provider business mailing address

PO BOX 489
MATTESON IL
60443-0489
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-6569
  • Fax: 708-499-1511
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-073878
License Number StateIL

VIII. Authorized Official

Name: SUBASH C ARORA
Title or Position: OWNER
Credential: M.D.
Phone: 708-422-6569