Healthcare Provider Details

I. General information

NPI: 1750685418
Provider Name (Legal Business Name): 4 KIDS PEDIATRICS S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W DUNDEE RD EAST ENTRANCE
WHEELING IL
60090-3936
US

IV. Provider business mailing address

1111 W DUNDEE RD EAST ENTRANCE
WHEELING IL
60090-3936
US

V. Phone/Fax

Practice location:
  • Phone: 224-676-0905
  • Fax: 224-676-0714
Mailing address:
  • Phone: 224-676-0905
  • Fax: 224-676-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036121890
License Number StateIL

VIII. Authorized Official

Name: LILA ELMAN
Title or Position: PEDIATRICIAN
Credential: M.D,F.A.A.P
Phone: 224-676-0905