Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
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

22638 GRANITE DR
FRANKFORT IL
60423-8979
US

V. Phone/Fax

Practice location:
  • Phone: 815-934-8444
  • Fax: 815-717-7229
Mailing address:
  • Phone: 708-601-0890
  • Fax: 815-717-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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