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General NPI Number Information
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NPI Number | 1053535591
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MEDICAL SERVICES
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9669 KENTON AVE STE 403
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City | SKOKIE
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State | IL
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Zip | 60076-1266
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Country | US
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Telephone | 847-674-4730
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Fax | 847-674-4732
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Provider Business Mailing Address
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Address Line | 9669 KENTON AVE STE 403
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City | SKOKIE
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State | IL
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Zip | 60076-1266
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Country | US
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Telephone | 847-674-4730
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Fax | 847-674-4732
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUNA YI
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Credential |
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Telephone | 847-674-4730
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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 |
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License Number State |
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