Provider Demographics
NPI:1821008657
Name:JUST FOR KIDS PEDIATRICS PC
Entity Type:Organization
Organization Name:JUST FOR KIDS PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KWIATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-682-1130
Mailing Address - Street 1:200 E WILLOW AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5449
Mailing Address - Country:US
Mailing Address - Phone:630-682-1130
Mailing Address - Fax:630-682-0706
Practice Address - Street 1:200 E WILLOW AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5449
Practice Address - Country:US
Practice Address - Phone:630-682-1130
Practice Address - Fax:630-682-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009035208000000X
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2223081OtherBLUE CROSS
C48700Medicare UPIN