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General NPI Number Information
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NPI Number | 1306829353
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Entity Type | Organization
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Legal Business Name | AURORA PEDIATRIC CLINIC SC
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 N HIGHLAND AVE STE 4
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City | AURORA
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State | IL
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Zip | 60506-1451
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Country | US
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Telephone | 630-896-7788
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Fax | 630-896-7794
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Provider Business Mailing Address
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Address Line | 1300 N HIGHLAND AVE STE 4
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City | AURORA
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State | IL
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Zip | 60506-1451
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Country | US
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Telephone | 630-896-7788
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Fax | 630-896-7794
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. CRISPIN HAO
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Credential | MD
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Telephone | 630-896-7788
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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 | 36045223
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License Number State | IL
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