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General NPI Number Information
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NPI Number | 1851410062
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Entity Type | Organization
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Legal Business Name | BRAD JONES PROGRESSIVE PEDIATRICS PC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 3000 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2422
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Country | US
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Telephone | 847-480-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 DUNDEE RD SUITE 418
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City | NORTHBROOK
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State | IL
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Zip | 60062-2422
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Country | US
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Telephone | 847-480-7833
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRAD JONES
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Credential |
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Telephone | 847-480-7833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 056 003367
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License Number State | IL
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