Healthcare Provider Details

I. General information

NPI: 1790479459
Provider Name (Legal Business Name): C & C PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16750 80TH AVE STE D
TINLEY PARK IL
60477-3174
US

IV. Provider business mailing address

16750 80TH AVE STE D
TINLEY PARK IL
60477-3174
US

V. Phone/Fax

Practice location:
  • Phone: 815-934-8444
  • Fax: 815-717-7229
Mailing address:
  • Phone: 815-934-8444
  • Fax: 815-717-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AKILAH LATISH COOK
Title or Position: PRESIDENT
Credential: MD
Phone: 708-601-0890