Provider Demographics
NPI:1912203209
Name:MATERNAL AND CHILD MEDICAL CARE, S.C
Entity Type:Organization
Organization Name:MATERNAL AND CHILD MEDICAL CARE, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ORAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKAVACHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-650-1452
Mailing Address - Street 1:2055 WEST ARMY TRAIL ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:847-650-1452
Mailing Address - Fax:224-535-7260
Practice Address - Street 1:2055 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1478
Practice Address - Country:US
Practice Address - Phone:847-650-1452
Practice Address - Fax:224-535-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty