Provider Demographics
NPI:1578745071
Name:GROVE PEDIATRICS LTD
Entity Type:Organization
Organization Name:GROVE PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-465-9600
Mailing Address - Street 1:135 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 152
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8213
Mailing Address - Country:US
Mailing Address - Phone:847-465-9600
Mailing Address - Fax:847-465-9601
Practice Address - Street 1:135 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 152
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8213
Practice Address - Country:US
Practice Address - Phone:847-465-9600
Practice Address - Fax:847-465-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03605772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty