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General NPI Number Information
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NPI Number | 1285128561
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Entity Type | Organization
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Legal Business Name | SOUTH LOOP PEDIATRICS, LLC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 2329 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616-2104
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Country | US
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Telephone | 312-265-1244
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Fax | 312-265-1174
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Provider Business Mailing Address
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Address Line | 2329 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616-2104
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Country | US
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Telephone | 312-265-1244
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Fax | 312-265-1174
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. KIMBERLY THERESE BROWN
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Credential | MD
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Telephone | 312-265-1244
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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 | 24800
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License Number State | IL
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