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General NPI Number Information
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NPI Number | 1881609287
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Entity Type | Organization
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Legal Business Name | WOODFIELD PEDIATRICS SC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 1345 WILEY RD STE 117
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City | SCHAUMBURG
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State | IL
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Zip | 60173
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Country | US
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Telephone | 847-884-9440
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Fax | 847-884-8051
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Provider Business Mailing Address
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Address Line | 1345 WILEY RD STE 117
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City | SCHAUMBURG
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State | IL
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Zip | 60173
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Country | US
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Telephone | 847-884-9440
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Fax | 847-884-9440
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Authorized Official
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Title or Position | MS
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Name | RONALD JOSEPH BODUCH
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Credential | MD
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Telephone | 847-884-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State | IL
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