Provider Demographics
NPI:1033299649
Name:LAGRANGE PEDIATRICS LTD
Entity Type:Organization
Organization Name:LAGRANGE PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-588-0088
Mailing Address - Street 1:4727 WILLOW SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-588-0088
Mailing Address - Fax:708-588-0588
Practice Address - Street 1:4727 WILLOW SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-588-0088
Practice Address - Fax:708-588-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty