Provider Demographics
NPI:1710168299
Name:PRECIOUS HEARTS PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:PRECIOUS HEARTS PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANJOORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-375-0707
Mailing Address - Street 1:1595 E OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2120
Mailing Address - Country:US
Mailing Address - Phone:847-375-0707
Mailing Address - Fax:847-375-0808
Practice Address - Street 1:1595 E OAKTON ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2120
Practice Address - Country:US
Practice Address - Phone:847-375-0707
Practice Address - Fax:847-375-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087868Medicaid
IL91647858OtherBLUE CROSS PROVIDER
IL1063575397OtherDR.MANJOORAN NPI