MEDICARE: NORTH PARK 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
1	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1881725091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PARK PEDIATRICS, S. C.

Provider Business Mailing Address
First Line	:	5240 N PULASKI RD STE E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1761
Country	:	US
Telephone Number	:	773-463-7337
Fax Number	:	773-478-5025

Provider Business Practice Location Address
First Line	:	5240 N PULASKI RD STE E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1761
Country	:	US
Telephone Number	:	773-463-7337
Fax Number	:	773-478-5025

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. BRIAN SCOTT MORSE
Credential	:	MD, PHD
Telephone Number	:	773-463-7337

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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