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General NPI Number Information
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NPI Number | 1053577387
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Entity Type | Organization
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Legal Business Name | A TO Z PEDIATRICS, LLP
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 1230 GEORGE E. CHANCE PARKWAY
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City | CASEYVILLE
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State | IL
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Zip | 62232
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Country | US
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Telephone | 618-345-5437
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Fax | 618-377-8279
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Provider Business Mailing Address
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Address Line | 1230 GEORGE E. CHANCE PARKWAY
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City | CASEYVILLE
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State | IL
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Zip | 62232
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Country | US
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Telephone | 618-345-5437
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Fax | 618-377-8279
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. CASSANDRA DEE EBERHART
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Credential |
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Telephone | 618-623-9468
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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 | 036.115360
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License Number State | IL
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