Healthcare Provider Details

I. General information

NPI: 1518979327
Provider Name (Legal Business Name): PARK RIDGE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WASHINGTON AVE SUITE 122
PARK RIDGE IL
60068-4200
US

IV. Provider business mailing address

101 S WASHINGTON AVE SUITE 122
PARK RIDGE IL
60068-4200
US

V. Phone/Fax

Practice location:
  • Phone: 847-692-6628
  • Fax: 847-692-6891
Mailing address:
  • Phone: 847-692-6628
  • Fax: 847-692-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARIA ROMA HRYCELAK
Title or Position: OWNER
Credential: M.D.
Phone: 847-692-6628