Provider Demographics
NPI:1841441953
Name:FOX VALLEYPEDIATRICS
Entity type:Organization
Organization Name:FOX VALLEYPEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:URMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALSANIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-844-9963
Mailing Address - Street 1:143 S LINCOLN AVE
Mailing Address - Street 2:STE- L
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4263
Mailing Address - Country:US
Mailing Address - Phone:630-844-9963
Mailing Address - Fax:630-844-9973
Practice Address - Street 1:143 S LINCOLN AVE
Practice Address - Street 2:STE- L
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4263
Practice Address - Country:US
Practice Address - Phone:630-844-9963
Practice Address - Fax:630-844-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060723261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060723Medicaid