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General NPI Number Information
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NPI Number | 1568580371
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Entity Type | Organization
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Legal Business Name | PEDIATRIC GENERAL CARE & RESEARCH FUND
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 5137 W CHICAGO AVE.
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City | CHICAGO
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State | IL
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Zip | 60651-2904
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Country | US
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Telephone | 773-378-4664
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Fax | 888-726-8579
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Provider Business Mailing Address
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Address Line | 2390 DORINA DR
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City | NORTHFIELD
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State | IL
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Zip | 60093-2706
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Country | US
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Telephone | 773-278-4664
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Fax | 888-726-8579
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHANDRA MOHINI KHURANA
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Credential | M.D.
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Telephone | 773-378-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036048694
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License Number State | IL
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