Provider Demographics
NPI:1477695971
Name:NORTHWEST PEDIATRIC SERVICES, S.C.
Entity Type:Organization
Organization Name:NORTHWEST PEDIATRIC SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKAVACHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-888-3631
Mailing Address - Street 1:373 SUMMIT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3733
Mailing Address - Country:US
Mailing Address - Phone:847-888-3631
Mailing Address - Fax:847-888-3632
Practice Address - Street 1:373 SUMMIT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3733
Practice Address - Country:US
Practice Address - Phone:847-888-3631
Practice Address - Fax:847-888-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty