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NPI Code Detail

MEDICARE: PEDIATRIC SPECIALISTS OF THE NW MDSC

MEDICARE: PEDIATRIC SPECIALISTS OF THE NW MDSC
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 : 1770568016
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC SPECIALISTS OF THE NW MDSC
Provider Business Mailing Address
First Line : 5057 SHORELINE RD
Second Line :
City : LAKE BARRINGTON
State : IL
Zip : 60010-1700
Country : US
Telephone Number : 847-381-5005
Fax Number : 847-381-5036
Provider Business Practice Location Address
First Line : 5057 SHORELINE RD
Second Line :
City : LAKE BARRINGTON
State : IL
Zip : 60010-1700
Country : US
Telephone Number : 847-381-5005
Fax Number : 847-381-5036
Authorized Official
Title or Position : HEAD DOCTOR
Name : DR. CHARLES M BRAVERMAN
Credential : MD
Telephone Number : 847-381-5005
Provider Enumeration Date : 12/09/2005
Last Update Date : 08/22/2020

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Directions to “PEDIATRIC SPECIALISTS OF THE NW MDSC ” Practice Location

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