Provider Demographics
NPI:1023294519
Name:CENTER FOR AUTONOMIC MEDICINE IN PEDIATRICS
Entity type:Organization
Organization Name:CENTER FOR AUTONOMIC MEDICINE IN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-573-4515
Mailing Address - Street 1:2300 N CHILDRENS PLZ # 64
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:312-573-4515
Mailing Address - Fax:312-573-8405
Practice Address - Street 1:2300 N CHILDRENS PLZ # 64
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:312-573-4515
Practice Address - Fax:312-573-8405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC FACULTY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty