Provider Demographics
NPI:1053631879
Name:ALL ABOUT KIDS PEDIATRICS, S.C.
Entity Type:Organization
Organization Name:ALL ABOUT KIDS PEDIATRICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-355-6996
Mailing Address - Street 1:100 SPALDING DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6550
Mailing Address - Country:US
Mailing Address - Phone:630-355-6996
Mailing Address - Fax:630-355-0026
Practice Address - Street 1:100 SPALDING DR
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6550
Practice Address - Country:US
Practice Address - Phone:630-355-6996
Practice Address - Fax:630-355-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03000694Medicaid