Basic Information
| Provider Information | |||||||||
| NPI: | 1780729145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SUBURBAN PEDIATRICS, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2530 RIDGE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602012492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478690892 | ||||||||
| FaxNumber: | 8478691070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2530 RIDGE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602012492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478690892 | ||||||||
| FaxNumber: | 8478691070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KIRSCHBAUM | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8478696485 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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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.