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NPI Code Detail

MEDICARE: SUNSHINE PEDIATRICS, S.C.

MEDICARE: SUNSHINE PEDIATRICS, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician036108990IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14932453OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1053417741
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNSHINE PEDIATRICS, S.C.
Provider Business Mailing Address
First Line : 214 WASHINGTON ST
Second Line : STE 3
City : INGLESIDE
State : IL
Zip : 60041-9208
Country : US
Telephone Number : 847-587-9090
Fax Number : 847-587-9093
Provider Business Practice Location Address
First Line : 214 WASHINGTON ST
Second Line : STE 3
City : INGLESIDE
State : IL
Zip : 60041-9208
Country : US
Telephone Number : 847-587-9090
Fax Number : 847-587-9093
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM UTLEY
Credential : M.D.
Telephone Number : 847-587-9090
Provider Enumeration Date : 09/16/2006
Last Update Date : 02/17/2010

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Directions to “SUNSHINE PEDIATRICS, S.C. ” Practice Location

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