Healthcare Provider Details

I. General information

NPI: 1609990894
Provider Name (Legal Business Name): KATERJI PEDIATRIC NEUROLOGY & ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 JORIE BLVD SUITE 220
OAK BROOK IL
60523-3846
US

IV. Provider business mailing address

900 JORIE BLVD SUITE 220
OAK BROOK IL
60523-3846
US

V. Phone/Fax

Practice location:
  • Phone: 630-645-9900
  • Fax: 630-645-9910
Mailing address:
  • Phone: 630-645-9900
  • Fax: 630-645-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: M. AMMAR KATERJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-645-9900