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General NPI Number Information
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NPI Number | 1780724898
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Entity Type | Organization
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Legal Business Name | CHICAGO PEDIATRIC CLINIC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1918 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60613-2408
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Country | US
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Telephone | 773-477-4900
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Fax | 773-477-4478
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DARLENE EGUES
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Credential | M.D.
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Telephone | 773-477-4900
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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 | IL
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