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Pediatric Critical Care Medicine >> Pediatrics >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1629128657

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
180 HARVESTER DR STE 110  BURR RIDGE, IL 60527-6686 US
Tel: 773-834-4064  Fax: --

Contact information for business:
5841 S MARYLAND AVE # MC1099  CHICAGO, IL 60637-1447 US
Tel: --  Fax: --

Registration Information:
NPI: 1629128657
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2080P0203XAllopathic & Osteopathic Physicians
Pediatric Critical Care Medicine

Legacy codes, insurance codes and state license numbers:



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