Provider Demographics
NPI:1326243429
Name:SANDERS COURT PEDIATRICS, LTD.
Entity Type:Organization
Organization Name:SANDERS COURT PEDIATRICS, LTD.
Other - Org Name:SANDERS ARLINGTON PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PERVOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-259-5900
Mailing Address - Street 1:1450 BUSCH PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4541
Mailing Address - Country:US
Mailing Address - Phone:847-499-3070
Mailing Address - Fax:847-499-3089
Practice Address - Street 1:1450 BUSCH PKWY STE 130
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4541
Practice Address - Country:US
Practice Address - Phone:847-499-3070
Practice Address - Fax:847-499-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15609Medicare UPIN