Healthcare Provider Details

I. General information

NPI: 1750361333
Provider Name (Legal Business Name): DONALD S CHILDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE SUITE 2500
OAK PARK IL
60304-1091
US

IV. Provider business mailing address

610 S MAPLE AVE SUITE 2500
OAK PARK IL
60304-1091
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-2900
  • Fax: 708-660-2901
Mailing address:
  • Phone: 708-660-2900
  • Fax: 708-660-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036081440
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: