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General NPI Number Information
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NPI Number | 1700241924
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Entity Type | Organization
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Legal Business Name | NORTHSTAR PEDIATRICS INC.
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 2613 W EVERGREEN AVE APT 1F
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City | CHICAGO
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State | IL
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Zip | 60622-2873
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Country | US
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Telephone | 480-313-6777
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Fax | 855-810-1930
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Provider Business Mailing Address
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Address Line | 2613 W EVERGREEN AVE APT 1F
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City | CHICAGO
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State | IL
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Zip | 60622-2873
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Country | US
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Telephone | 480-313-6777
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Fax | 855-810-1930
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Authorized Official
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Title or Position | CEO
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Name | MS. ALEXIS HAMILTON
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Credential | M.S.
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Telephone | 480-313-6777
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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 |
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