Healthcare Provider Details

I. General information

NPI: 1194941757
Provider Name (Legal Business Name): FAIRVIEW PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 E BELVIDERE RD SUITE 315
GRAYSLAKE IL
60030-2016
US

IV. Provider business mailing address

1475 E BELVIDERE RD SUITE 315
GRAYSLAKE IL
60030-2016
US

V. Phone/Fax

Practice location:
  • Phone: 847-548-8777
  • Fax: 847-548-8899
Mailing address:
  • Phone: 847-548-8777
  • Fax: 847-548-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. JANICE MARIE KRAKORA-LOOBY
Title or Position: MEMBER
Credential: MD
Phone: 847-548-8777