Provider Demographics
NPI:1386187458
Name:A2Z CARE MED-PEDS SPECIALISTS, PC
Entity Type:Organization
Organization Name:A2Z CARE MED-PEDS SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGEMENT CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-712-4010
Mailing Address - Street 1:3250 LACEY RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7901
Mailing Address - Country:US
Mailing Address - Phone:708-712-4010
Mailing Address - Fax:
Practice Address - Street 1:550 EAST BOUGTON ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2194
Practice Address - Country:US
Practice Address - Phone:630-755-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361146362080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114636Medicaid
ILF400104376Medicare PIN