MEDICARE: NORTHSTAR PEDIATRICS 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	174400000X	Specialist

General Provider Information

NPI Number	:	1700241924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTAR PEDIATRICS INC.

Provider Business Mailing Address
First Line	:	2613 W EVERGREEN AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2873
Country	:	US
Telephone Number	:	480-313-6777
Fax Number	:	855-810-1930

Provider Business Practice Location Address
First Line	:	2613 W EVERGREEN AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2873
Country	:	US
Telephone Number	:	480-313-6777
Fax Number	:	855-810-1930

Authorized Official
Title or Position	:	CEO
Name	:	MS. ALEXIS HAMILTON
Credential	:	M.S.
Telephone Number	:	480-313-6777

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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