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General NPI Number Information
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NPI Number | 1568630234
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PEDIATRIC CARE
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 657 E. GOLF RD SUITE 309
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-4968
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Country | US
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Telephone | 224-404-6000
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Fax | 773-774-0019
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Provider Business Mailing Address
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Address Line | 657 E. GOLF RD SUITE 309
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-4968
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Country | US
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Telephone | 224-404-6000
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Fax | 773-774-0019
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Authorized Official
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Title or Position | M.D
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Name | MARIOLA JACKOWSKI
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Credential | M.D
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Telephone | 224-404-6000
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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 | 036118003
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License Number State | IL
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