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General NPI Number Information
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NPI Number | 1407032022
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND COMMUNITY PEDIATRIC CARDIOLOGY SC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 2923 N CALIFORNIA AVE SUITE 230
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City | CHICAGO
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State | IL
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Zip | 60618-4677
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Country | US
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Telephone | 312-951-5800
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Fax | 312-951-5816
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Provider Business Mailing Address
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Address Line | 2923 N CALIFORNIA AVE SUITE 230
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City | CHICAGO
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State | IL
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Zip | 60618-4677
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Country | US
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Telephone | 312-951-5800
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Fax | 312-951-5816
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DEBRA SCHAFFER
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Credential |
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Telephone | 630-217-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 042007521
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License Number State | IL
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