Provider Demographics
NPI:1245491851
Name:CHILDREN'S PHYSICIAN GROUP
Entity type:Organization
Organization Name:CHILDREN'S PHYSICIAN GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHILDREN'S PHYSICIAN GRP
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-266-7615
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 8000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-3803
Practice Address - Street 1:1027 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2550
Practice Address - Country:US
Practice Address - Phone:847-367-2615
Practice Address - Fax:847-367-1801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S PHYSICIAN GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty