Provider Demographics
NPI:1346313160
Name:COMPREHENSIVE PEDIATRIC CARE LTD
Entity Type:Organization
Organization Name:COMPREHENSIVE PEDIATRIC CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANVEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-854-6682
Mailing Address - Street 1:PO BOX 7388
Mailing Address - Street 2:COMPREHENSIVE PEDIATRIC CARE LTD.
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-7388
Mailing Address - Country:US
Mailing Address - Phone:708-891-0089
Mailing Address - Fax:708-891-0681
Practice Address - Street 1:1600 167TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5457
Practice Address - Country:US
Practice Address - Phone:708-891-0089
Practice Address - Fax:708-891-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF42286Medicare UPIN