Provider Demographics
NPI:1073794756
Name:BOLINGBROOK PEDIATRICS, SC
Entity Type:Organization
Organization Name:BOLINGBROOK PEDIATRICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARAMJEET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-759-5000
Mailing Address - Street 1:439 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1821
Mailing Address - Country:US
Mailing Address - Phone:630-759-5000
Mailing Address - Fax:630-759-4567
Practice Address - Street 1:439 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1821
Practice Address - Country:US
Practice Address - Phone:630-759-5000
Practice Address - Fax:630-759-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090470261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090470Medicaid