MEDICARE: DONOHOE PEDIATRICS LTD.

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

General Provider Information

NPI Number	:	1952897969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONOHOE PEDIATRICS LTD.

Provider Business Mailing Address
First Line	:	3916 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3906
Country	:	US
Telephone Number	:	773-644-1362
Fax Number	:	773-828-4849

Provider Business Practice Location Address
First Line	:	3916 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3906
Country	:	US
Telephone Number	:	773-644-1362
Fax Number	:	773-828-4849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTOPHER DONOHOE
Credential	:	MD
Telephone Number	:	773-644-1362

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/03/2018

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