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General NPI Number Information
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NPI Number | 1013418854
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Entity Type | Organization
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Legal Business Name | WILLOW PEDIATRICS AND LACTATION
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 1430 W. FILLMORE ST. #1E
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City | CHICAGO
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State | IL
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Zip | 60607
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Country | US
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Telephone | 312-869-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 2518 W ADDISON ST APT 2W
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City | CHICAGO
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State | IL
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Zip | 60618-5953
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Country | US
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Telephone | 312-697-9307
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CHIEF PHYSICIAN
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Name | DR. AMBER NICOLE PRICE
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Credential | MD
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Telephone | 312-869-9556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036144763
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License Number State | IL
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