Provider Demographics
NPI:1003100942
Name:CICERO PEDIATRICS
Entity Type:Organization
Organization Name:CICERO PEDIATRICS
Other - Org Name:KHUDSIA IRFAN SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHUDSIA
Authorized Official - Middle Name:RANA
Authorized Official - Last Name:IRFAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:630-797-1411
Mailing Address - Street 1:5307 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2817
Mailing Address - Country:US
Mailing Address - Phone:708-477-6700
Mailing Address - Fax:708-477-6704
Practice Address - Street 1:5307 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2817
Practice Address - Country:US
Practice Address - Phone:708-477-6700
Practice Address - Fax:708-477-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty