Basic Information
| Provider Information | |||||||||
| NPI: | 1134244908 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATION OF CHILDCARE PHYSICIANS LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4969 BENCHMARK CENTRE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622268928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182352311 | ||||||||
| FaxNumber: | 6185893335 | ||||||||
| Practice Location | |||||||||
| Address1: | 4969 BENCHMARK CENTRE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SWANSEA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622268928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182352311 | ||||||||
| FaxNumber: | 6185893335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | KELLOW | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6182353211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 060007437 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.