Provider Demographics
NPI:1821370529
Name:PALATINE PEDIATRICS
Entity Type:Organization
Organization Name:PALATINE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-359-5000
Mailing Address - Street 1:600 N NORTH CT STE 115
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8167
Mailing Address - Country:US
Mailing Address - Phone:847-359-5000
Mailing Address - Fax:847-359-5395
Practice Address - Street 1:600 N NORTH CT STE 115
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8167
Practice Address - Country:US
Practice Address - Phone:847-359-5000
Practice Address - Fax:847-359-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100887261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100887Medicaid