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General NPI Number Information
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NPI Number | 1750685418
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Entity Type | Organization
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Legal Business Name | 4 KIDS PEDIATRICS S.C
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 1111 W DUNDEE RD EAST ENTRANCE
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City | WHEELING
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State | IL
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Zip | 60090-3936
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Country | US
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Telephone | 224-676-0905
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Fax | 224-676-0714
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Provider Business Mailing Address
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Address Line | 1111 W DUNDEE RD EAST ENTRANCE
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City | WHEELING
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State | IL
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Zip | 60090-3936
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Country | US
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Telephone | 224-676-0905
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Fax | 224-676-0714
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | LILA ELMAN
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Credential | M.D,F.A.A.P
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Telephone | 224-676-0905
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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 | 036121890
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License Number State | IL
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