Provider Demographics
NPI:1578752739
Name:KIDS UROLOGY. S.C.
Entity Type:Organization
Organization Name:KIDS UROLOGY. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-880-3252
Mailing Address - Street 1:2300 N CHILDRENS PLZ # 24
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-3252
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ # 24
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-3252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty