Provider Demographics
NPI:1740483718
Name:CHILDREN'S MEDICAL GROUP, S.C.
Entity type:Organization
Organization Name:CHILDREN'S MEDICAL GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:TJADEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-658-6065
Mailing Address - Street 1:301 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5961
Mailing Address - Country:US
Mailing Address - Phone:847-658-6065
Mailing Address - Fax:847-658-6136
Practice Address - Street 1:301 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5961
Practice Address - Country:US
Practice Address - Phone:847-658-6065
Practice Address - Fax:847-658-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty