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General NPI Number Information
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NPI Number | 1568531903
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CLINIC LTD.
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6416 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3921
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Country | US
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Telephone | 773-725-5400
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Fax | 773-725-4704
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Provider Business Mailing Address
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Address Line | 6416 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3921
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Country | US
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Telephone | 773-725-5400
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Fax | 773-725-4704
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA STAISZ
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Credential | M.D.
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Telephone | 773-725-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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