Provider Demographics
NPI:1568649838
Name:HOMER GLEN PEDIATRICS, SC
Entity Type:Organization
Organization Name:HOMER GLEN PEDIATRICS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GIROUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-301-5050
Mailing Address - Street 1:12701 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7808
Mailing Address - Country:US
Mailing Address - Phone:708-301-5050
Mailing Address - Fax:708-645-6320
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7808
Practice Address - Country:US
Practice Address - Phone:708-301-5050
Practice Address - Fax:708-645-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty