MEDICARE: JOLIET PEDIATRICS AND FAMILY CARE INC

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	208000000X	Pediatrics Physician
2	261QP2300X	Primary Care Clinic/Center	036089109	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619193760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLIET PEDIATRICS AND FAMILY CARE INC

Provider Business Mailing Address
First Line	:	831 NORTH LARKIN AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435
Country	:	US
Telephone Number	:	815-741-8888
Fax Number	:	815-730-3323

Provider Business Practice Location Address
First Line	:	831 NORTH LARKIN AVE
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-3460
Country	:	US
Telephone Number	:	815-741-8888
Fax Number	:	815-730-3323

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHERAHSAN KHAN NIAZI
Credential	:	MD
Telephone Number	:	815-741-8888

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/22/2025

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