Healthcare Provider Details

I. General information

NPI: 1326656125
Provider Name (Legal Business Name): KIDS PEDIATRICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 W LOOP RD
WHEATON IL
60189-2034
US

IV. Provider business mailing address

288 W LOOP RD
WHEATON IL
60189-2034
US

V. Phone/Fax

Practice location:
  • Phone: 630-868-3620
  • Fax:
Mailing address:
  • Phone: 630-868-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PATRICE PASH
Title or Position: DIRECTOR OF CLIENT SERVICES
Credential:
Phone: 815-995-7066