Provider Demographics
NPI:1841467008
Name:CHICAGOLAND PEDIATRIC PARTNERS PC
Entity type:Organization
Organization Name:CHICAGOLAND PEDIATRIC PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY-PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-6400
Mailing Address - Street 1:4700 W 95TH ST
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2533
Mailing Address - Country:US
Mailing Address - Phone:708-423-6400
Mailing Address - Fax:708-423-6428
Practice Address - Street 1:4700 W 95TH ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2533
Practice Address - Country:US
Practice Address - Phone:708-423-6400
Practice Address - Fax:708-423-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059573A261QP2300X
IL036078773261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078773Medicaid
IL705540OtherMEDICARE NATIONAL PROVIDER NUMBER
IL036078773Medicaid