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NPI Code Detail

MEDICARE: PEDIATRIC GENERAL CARE & RESEARCH FUND

MEDICARE: PEDIATRIC GENERAL CARE & RESEARCH FUND
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
1207Q00000XFamily Medicine Physician
2208000000XPediatrics Physician
3208000000XPediatrics Physician036048694IL

General Provider Information

NPI Number : 1568580371
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC GENERAL CARE & RESEARCH FUND
Provider Business Mailing Address
First Line : 2390 DORINA DR
Second Line :
City : NORTHFIELD
State : IL
Zip : 60093-2706
Country : US
Telephone Number : 773-278-4664
Fax Number : 888-726-8579
Provider Business Practice Location Address
First Line : 5137 W CHICAGO AVE.
Second Line :
City : CHICAGO
State : IL
Zip : 60651-2904
Country : US
Telephone Number : 773-378-4664
Fax Number : 888-726-8579
Authorized Official
Title or Position : PRESIDENT
Name : DR. CHANDRA MOHINI KHURANA
Credential : M.D.
Telephone Number : 773-378-4664
Provider Enumeration Date : 03/27/2007
Last Update Date : 08/25/2011

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Directions to “PEDIATRIC GENERAL CARE & RESEARCH FUND ” Practice Location

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