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General NPI Number Information
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NPI Number | 1770756942
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Entity Type | Organization
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Legal Business Name | CHICAGO PEDIATRIC CARE, INC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9902 W ROOSEVELT RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2770
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Country | US
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Telephone | 708-343-4620
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Fax | 708-343-4632
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Provider Business Mailing Address
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Address Line | 1516 WILLOW CREEK LN
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City | DARIEN
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State | IL
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Zip | 60561-5394
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Country | US
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Telephone | 708-343-4620
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Fax | 708-343-4632
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Authorized Official
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Title or Position | OWNER
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Name | DR. SARA VERGHESE
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Credential | M.D., F.A.A.P
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Telephone | 708-343-4620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | IL
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