Provider Demographics
NPI:1740308196
Name:TOWN AND COUNTRY PEDIATRICS
Entity type:Organization
Organization Name:TOWN AND COUNTRY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-279-8900
Mailing Address - Street 1:1460 N HALSTED ST STE 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2607
Mailing Address - Country:US
Mailing Address - Phone:312-279-8900
Mailing Address - Fax:312-981-6312
Practice Address - Street 1:1460 N HALSTED ST STE 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2607
Practice Address - Country:US
Practice Address - Phone:312-279-8900
Practice Address - Fax:312-981-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD42002840208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000693479-001OtherUHC
IL5115639OtherAETNA
IL1616281OtherBCBS