Provider Demographics
NPI:1881609287
Name:WOODFIELD PEDIATRICS SC
Entity type:Organization
Organization Name:WOODFIELD PEDIATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BODUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-9440
Mailing Address - Street 1:1345 WILEY RD
Mailing Address - Street 2:STE 117
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173
Mailing Address - Country:US
Mailing Address - Phone:847-884-9440
Mailing Address - Fax:847-884-9440
Practice Address - Street 1:1345 WILEY RD
Practice Address - Street 2:STE 117
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:847-884-9440
Practice Address - Fax:847-884-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty