Provider Demographics
NPI:1134207111
Name:NORTHSIDE NEONATAL AND INFANT CARE SC
Entity type:Organization
Organization Name:NORTHSIDE NEONATAL AND INFANT CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-655-4707
Mailing Address - Street 1:9410 COMPUBILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-460-7444
Mailing Address - Fax:708-460-8662
Practice Address - Street 1:836 W WELLINGTON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-296-7047
Practice Address - Fax:773-296-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty