Provider Demographics
NPI:1073774683
Name:CHILDREN'S PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CHILDREN'S PHYSICIAN GROUP
Other - Org Name:BUFFALO GROVE CLNIIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, CHILDREN'S PHYSICIAN GRO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-266-7615
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 8000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-3803
Practice Address - Street 1:135 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:#160
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8213
Practice Address - Country:US
Practice Address - Phone:847-215-8858
Practice Address - Fax:847-215-9478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty