Provider Demographics
NPI:1760561617
Name:PILSEN COMMUNITY PEDIATRICS S. C.
Entity Type:Organization
Organization Name:PILSEN COMMUNITY PEDIATRICS S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:E
Authorized Official - Last Name:OROZA-HENNERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-666-5455
Mailing Address - Street 1:1859 S BLUE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3012
Mailing Address - Country:US
Mailing Address - Phone:312-666-5455
Mailing Address - Fax:
Practice Address - Street 1:1859 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3012
Practice Address - Country:US
Practice Address - Phone:312-666-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty