Healthcare Provider Details

I. General information

NPI: 1710103098
Provider Name (Legal Business Name): PACE PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 KEOKUK RD
INDIAN HEAD PARK IL
60525-4341
US

IV. Provider business mailing address

6341 KEOKUK RD
INDIAN HEAD PARK IL
60525-4341
US

V. Phone/Fax

Practice location:
  • Phone: 708-790-4834
  • Fax:
Mailing address:
  • Phone: 708-790-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number056004383
License Number StateIL

VIII. Authorized Official

Name: KRISTA L MURPHY
Title or Position: OWNER
Credential: M.S., OTR/L
Phone: 708-790-4834