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General NPI Number Information
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NPI Number | 1821370529
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Entity Type | Organization
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Legal Business Name | PALATINE PEDIATRICS
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 600 N NORTH CT STE 115
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City | PALATINE
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State | IL
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Zip | 60067-8167
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Country | US
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Telephone | 847-359-5000
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Fax | 847-359-5395
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Provider Business Mailing Address
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Address Line | 600 N NORTH CT STE 115
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City | PALATINE
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State | IL
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Zip | 60067-8167
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Country | US
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Telephone | 847-359-5000
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Fax | 847-359-5395
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINE DUONG
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Credential | M.D.
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Telephone | 847-359-5000
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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 | 036100887
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License Number State | IL
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