MEDICARE: GLENBROOK 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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1326228503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENBROOK PEDIATRICS, S.C.

Provider Business Mailing Address
First Line	:	2551 COMPASS ROAD
Second Line	:	SUITE 100
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8042
Country	:	US
Telephone Number	:	847-729-6445
Fax Number	:	847-729-1106

Provider Business Practice Location Address
First Line	:	2551 COMPASS ROAD
Second Line	:	SUITE 100
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8042
Country	:	US
Telephone Number	:	847-729-6445
Fax Number	:	847-729-1106

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. PAMELA SPENCE
Credential	:	B.A.
Telephone Number	:	847-729-6445

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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