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General NPI Number Information
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NPI Number | 1134207111
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Entity Type | Organization
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Legal Business Name | NORTHSIDE NEONATAL AND INFANT CARE SC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 836 W WELLINGTON
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 773-296-7047
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Fax | 773-296-7459
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Provider Business Mailing Address
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Address Line | 9410 COMPUBILL DRIVE
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City | CHICAGO
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State | IL
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Zip | 60462
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Country | US
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Telephone | 708-460-7444
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Fax | 708-460-8662
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIVEK GHAI
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Credential | MD
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Telephone | 630-655-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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