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General NPI Number Information
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NPI Number | 1346313160
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PEDIATRIC CARE 1 LTD
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1600 167TH ST STE 250
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City | CALUMET CITY
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State | IL
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Zip | 60409-5484
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Country | US
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Telephone | 708-891-0089
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Fax | 708-891-0681
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Provider Business Mailing Address
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Address Line | PO BOX 7388 COMPREHENSIVE PEDIATRIC CARE LTD.
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City | VILLA PARK
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State | IL
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Zip | 60181-7388
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Country | US
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Telephone | 708-891-0089
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Fax | 708-891-0681
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAHIDA TANVEER
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Credential | MD
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Telephone | 708-891-0089
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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 | 036083262
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License Number State | IL
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