Basic Information
| Provider Information | |||||||||
| NPI: | 1659446755 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS HEALTH ASSOC LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 BIESTERFIELD RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479813677 | ||||||||
| FaxNumber: | 8476900215 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 BIESTERFIELD RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479813677 | ||||||||
| FaxNumber: | 8476900215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANTO | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8479813677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.