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General NPI Number Information
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NPI Number | 1174681555
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Entity Type | Organization
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Legal Business Name | ALL BEAR CUB PEDIATRICS, S.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 473 W ARMY TRAIL ROAD SUITE 102
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2674
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Country | US
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Telephone | 630-529-1000
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Fax | 630-529-7497
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Provider Business Mailing Address
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Address Line | 473 W ARMY TRAIL ROAD #102
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City | BLOOMINGDALE
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State | IL
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Zip | 60108
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Country | US
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Telephone | 630-529-6969
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Fax | 630-529-7497
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Authorized Official
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Title or Position | ACCT MANAGER
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Name | KEISHA ROLLS
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Credential |
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Telephone | 630-384-1254
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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 | 036051771
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License Number State | IL
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