Provider Demographics
NPI:1598951394
Name:CHILDREN'S PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CHILDREN'S PHYSICIAN GROUP
Other - Org Name:CHILDREN'S PHYSICIAN GROUP - VERNON HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-266-6404
Mailing Address - Street 1:701 WOODLANDS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3101
Mailing Address - Country:US
Mailing Address - Phone:847-883-9300
Mailing Address - Fax:847-883-0310
Practice Address - Street 1:701 WOODLANDS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3101
Practice Address - Country:US
Practice Address - Phone:847-883-9300
Practice Address - Fax:847-883-0310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-14
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048638261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care