Healthcare Provider Details

I. General information

NPI: 1174553119
Provider Name (Legal Business Name): PEDIAGROUP ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 ROOSEVELT RD
OAK PARK IL
60304-2303
US

IV. Provider business mailing address

6300 ROOSEVELT RD
OAK PARK IL
60304-2303
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-8240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN WALKER
Title or Position: OWNER
Credential:
Phone: 708-848-8240