Healthcare Provider Details

I. General information

NPI: 1598807075
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF BARRINGTON, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NORTHWEST HIGHWAY SUITE G-7
FOX RIVER GROVE IL
60021
US

IV. Provider business mailing address

912 NORTHWEST HIGHWAY SUITE G-7
FOX RIVER GROVE IL
60021
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-6700
  • Fax: 847-381-6828
Mailing address:
  • Phone: 847-381-6700
  • Fax: 847-381-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042006251
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number042006251
License Number StateIL

VIII. Authorized Official

Name: MRS. JUDITH A BROWN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-381-6700