Provider Demographics
NPI:1306829353
Name:AURORA PEDIATRIC CLINIC SC
Entity Type:Organization
Organization Name:AURORA PEDIATRIC CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISPIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-896-7788
Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-896-7788
Mailing Address - Fax:630-896-7794
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:STE 4
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-896-7788
Practice Address - Fax:630-896-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36045223208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty