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General NPI Number Information
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NPI Number | 1568649838
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Entity Type | Organization
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Legal Business Name | HOMER GLEN PEDIATRICS, SC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 12701 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-7808
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Country | US
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Telephone | 708-301-5050
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Fax | 708-645-6320
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Provider Business Mailing Address
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Address Line | 12701 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-7808
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Country | US
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Telephone | 708-301-5050
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Fax | 708-645-6320
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN H. GIROUX
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Credential | M.D.
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Telephone | 708-301-5050
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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 |
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License Number State |
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