Healthcare Provider Details

I. General information

NPI: 1386868404
Provider Name (Legal Business Name): J & K PEDIATRICS AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 W SHAMROCK LN SUITE 201
MCHENRY IL
60050-8289
US

IV. Provider business mailing address

4119 W SHAMROCK LN SUITE 201
MCHENRY IL
60050-8289
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-9407
  • Fax: 815-759-9475
Mailing address:
  • Phone: 815-759-9407
  • Fax: 815-759-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036104503
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOSEPH KLAWITTER
Title or Position: PHYSICAN
Credential: MD
Phone: 815-759-9407