Provider Demographics
NPI:1700908498
Name:AD-PARK PEDIATRIC ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:AD-PARK PEDIATRIC ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-543-3020
Mailing Address - Street 1:303 W LAKE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2586
Mailing Address - Country:US
Mailing Address - Phone:630-543-3020
Mailing Address - Fax:630-543-1551
Practice Address - Street 1:303 W LAKE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2586
Practice Address - Country:US
Practice Address - Phone:630-543-3020
Practice Address - Fax:630-543-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty