Provider Demographics
NPI:1790848877
Name:MED-PEDS SPECIALISTS S.C.
Entity Type:Organization
Organization Name:MED-PEDS SPECIALISTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-444-0097
Mailing Address - Street 1:15614 S HARLEM AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4402
Mailing Address - Country:US
Mailing Address - Phone:708-444-0097
Mailing Address - Fax:708-444-8252
Practice Address - Street 1:15614 S HARLEM AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4402
Practice Address - Country:US
Practice Address - Phone:708-444-0097
Practice Address - Fax:708-444-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618236207R00000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty