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General NPI Number Information
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NPI Number | 1760717318
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Entity Type | Organization
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Legal Business Name | NEXT GENERATION PEDIATRICS, L.L.C.
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 107 S MCLEAN BLVD STE B
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1822
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Country | US
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Telephone | 847-695-9900
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Fax | 847-695-9989
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Provider Business Mailing Address
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Address Line | 107 S MCLEAN BLVD STE B
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1822
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Country | US
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Telephone | 847-695-9900
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Fax | 847-695-9989
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DR. LAWRENCE CANADA
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Credential | MD
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Telephone | 847-695-9900
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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 | 036104509
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License Number State | IL
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