Healthcare Provider Details

I. General information

NPI: 1265606453
Provider Name (Legal Business Name): ALESSIA PEDIATRICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 US HIGHWAY 34 SUITE 2
PLANO IL
60545-9824
US

IV. Provider business mailing address

11000 US HIGHWAY 34 SUITE 2
PLANO IL
60545-9824
US

V. Phone/Fax

Practice location:
  • Phone: 630-552-8488
  • Fax:
Mailing address:
  • Phone: 630-552-8488
  • 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: JODI KRUSELY
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 630-390-1240