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General NPI Number Information
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NPI Number | 1962643502
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Entity Type | Organization
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Legal Business Name | J W MUSCADIN MD PEDIATRIC SERVICES INC
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 326 W 64TH ST STE 303
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City | CHICAGO
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State | IL
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Zip | 60621-3114
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Country | US
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Telephone | 773-874-3005
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Fax | 773-962-4638
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Provider Business Mailing Address
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Address Line | 326 W 64TH ST STE 303
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City | CHICAGO
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State | IL
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Zip | 60621-3114
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Country | US
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Telephone | 773-874-3005
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Fax | 773-962-4638
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JEAN-WILSON MUSCADIN
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Credential | MD
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Telephone | 773-874-3005
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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 | 036-063960
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License Number State | IL
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