Healthcare Provider Details

I. General information

NPI: 1669946802
Provider Name (Legal Business Name): PEDIATRICS ON DEMAND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

IV. Provider business mailing address

9939 SOUTHWEST HWY
OAK LAWN IL
60453-3767
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-0900
  • Fax:
Mailing address:
  • Phone: 708-424-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON KNOX
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 708-424-0900