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NPI Code Detail

MEDICARE: PILSEN COMMUNITY PEDIATRICS S. C.

MEDICARE: PILSEN COMMUNITY 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 Physician

General Provider Information

NPI Number : 1760561617
Entity Type Code : Organization
Provider Name (Legal Business Name) : PILSEN COMMUNITY PEDIATRICS S. C.
Provider Business Mailing Address
First Line : 1859 S BLUE ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3012
Country : US
Telephone Number : 312-666-5455
Fax Number :
Provider Business Practice Location Address
First Line : 1859 S BLUE ISLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3012
Country : US
Telephone Number : 312-666-5455
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : GUSTAVO E OROZA-HENNERS
Credential : M.D.
Telephone Number : 312-666-5455
Provider Enumeration Date : 11/03/2006
Last Update Date : 03/09/2012

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Directions to “PILSEN COMMUNITY PEDIATRICS S. C. ” Practice Location

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