Healthcare Provider Details

I. General information

NPI: 1881880094
Provider Name (Legal Business Name): PEARL S. PARK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD STE 305
NORTHBROOK IL
60062-2726
US

IV. Provider business mailing address

585 COVENTRY LN
BUFFALO GROVE IL
60089-4600
US

V. Phone/Fax

Practice location:
  • Phone: 224-344-3620
  • Fax:
Mailing address:
  • Phone: 224-344-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10025770
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036122338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: