Healthcare Provider Details

I. General information

NPI: 1053586180
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISCONSIN CLINICS-VERNON HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WOODLANDS PKWY SUITE 200
VERNON HILLS IL
60061-3101
US

IV. Provider business mailing address

9000 W WISCONSIN AVE MS 8000
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 847-793-5450
  • Fax:
Mailing address:
  • Phone: 414-266-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMS DUNIGAN
Title or Position: PRESIDENT, CHILDREN'S PHYSICIAN GRP
Credential: MD
Phone: 414-266-7615