Provider Demographics
NPI:1154500627
Name:ADVANCED PEDIATRICS- CHILDREN'S HEALTH ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:ADVANCED PEDIATRICS- CHILDREN'S HEALTH ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-956-5461
Mailing Address - Street 1:126 BIESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3657
Mailing Address - Country:US
Mailing Address - Phone:847-956-5461
Mailing Address - Fax:847-956-5462
Practice Address - Street 1:126 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3657
Practice Address - Country:US
Practice Address - Phone:847-956-5461
Practice Address - Fax:847-956-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14646084282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty