Provider Demographics
NPI:1619193760
Name:JOLIET PEDIATRICS AND FAMILY CARE INC
Entity Type:Organization
Organization Name:JOLIET PEDIATRICS AND FAMILY CARE INC
Other - Org Name:SAKN PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERAHSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-8888
Mailing Address - Street 1:1721 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5835
Mailing Address - Country:US
Mailing Address - Phone:815-741-8888
Mailing Address - Fax:815-730-3323
Practice Address - Street 1:1721 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5835
Practice Address - Country:US
Practice Address - Phone:815-741-8888
Practice Address - Fax:815-730-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10316Medicare UPIN