Provider Demographics
NPI:1265440663
Name:PEDIATRICS AND CHILD DEVELOPMENT CLINIC INC.
Entity type:Organization
Organization Name:PEDIATRICS AND CHILD DEVELOPMENT CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSSARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-658-4574
Mailing Address - Street 1:2575 W ALGONQUIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9403
Mailing Address - Country:US
Mailing Address - Phone:847-658-4574
Mailing Address - Fax:847-587-6113
Practice Address - Street 1:2575 W ALGONQUIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9403
Practice Address - Country:US
Practice Address - Phone:847-658-4574
Practice Address - Fax:847-587-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360924532080P0008X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092453Medicaid
IL05628082OtherBLUE CROSS/SHIELD
IL05628082OtherBLUE CROSS/SHIELD