Provider Demographics
NPI:1801811757
Name:SALUD PEDIATRICS SC
Entity type:Organization
Organization Name:SALUD PEDIATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-854-9402
Mailing Address - Street 1:600 S RANDALL RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5935
Mailing Address - Country:US
Mailing Address - Phone:847-854-9402
Mailing Address - Fax:847-854-9403
Practice Address - Street 1:600 S RANDALL RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5935
Practice Address - Country:US
Practice Address - Phone:847-854-9402
Practice Address - Fax:847-854-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632081OtherBLUE CROSS/BLUE SHIELD