Provider Demographics
NPI:1700241924
Name:NORTHSTAR PEDIATRICS INC.
Entity Type:Organization
Organization Name:NORTHSTAR PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:480-313-6777
Mailing Address - Street 1:2613 W EVERGREEN AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2873
Mailing Address - Country:US
Mailing Address - Phone:480-313-6777
Mailing Address - Fax:855-810-1930
Practice Address - Street 1:2613 W EVERGREEN AVE APT 1F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2873
Practice Address - Country:US
Practice Address - Phone:480-313-6777
Practice Address - Fax:855-810-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty