Provider Demographics
NPI:1750685418
Name:4 KIDS PEDIATRICS S.C
Entity Type:Organization
Organization Name:4 KIDS PEDIATRICS S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP
Authorized Official - Phone:224-676-0905
Mailing Address - Street 1:1111 W DUNDEE RD
Mailing Address - Street 2:EAST ENTRANCE
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3936
Mailing Address - Country:US
Mailing Address - Phone:224-676-0905
Mailing Address - Fax:224-676-0714
Practice Address - Street 1:1111 W DUNDEE RD
Practice Address - Street 2:EAST ENTRANCE
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3936
Practice Address - Country:US
Practice Address - Phone:224-676-0905
Practice Address - Fax:224-676-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty