Healthcare Provider Details

I. General information

NPI: 1558593053
Provider Name (Legal Business Name): PEDIATRICS ON DEMAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 03/01/2012
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: 708-424-1715
Mailing address:
  • Phone: 708-424-0900
  • Fax: 708-424-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036119511
License Number StateIL

VIII. Authorized Official

Name: AYMAN RAWDA
Title or Position: PRESIDENT
Credential: MD
Phone: 708-424-0900