Healthcare Provider Details

I. General information

NPI: 1316597164
Provider Name (Legal Business Name): PM PEDIATRICS OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 SHOWPLACE DR STE 119
NAPERVILLE IL
60564-5056
US

IV. Provider business mailing address

1 HOLLOW LN STE 301
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 630-470-4878
  • Fax: 630-870-1712
Mailing address:
  • Phone: 516-869-0650
  • Fax: 516-869-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTEN HANLY
Title or Position: DIRECTOR OF RCM OPERATIONS
Credential:
Phone: 516-207-7919