Provider Demographics
NPI:1174681555
Name:ALL BEAR CUB PEDIATRICS, S.C.
Entity Type:Organization
Organization Name:ALL BEAR CUB PEDIATRICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-384-1254
Mailing Address - Street 1:473 W ARMY TRAIL ROAD
Mailing Address - Street 2:#102
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:630-529-6969
Mailing Address - Fax:630-529-7497
Practice Address - Street 1:473 W ARMY TRAIL ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2674
Practice Address - Country:US
Practice Address - Phone:630-529-1000
Practice Address - Fax:630-529-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051771208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-051771Medicaid