Provider Demographics
NPI:1912930769
Name:DOWNERS GROVE PEDIATRICS LTD
Entity Type:Organization
Organization Name:DOWNERS GROVE PEDIATRICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CABANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-852-4551
Mailing Address - Street 1:6840 S. MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3493
Mailing Address - Country:US
Mailing Address - Phone:630-852-4551
Mailing Address - Fax:630-451-0131
Practice Address - Street 1:6840 S. MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3493
Practice Address - Country:US
Practice Address - Phone:630-852-4551
Practice Address - Fax:630-451-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-001840208000000X
IL042001840302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Multi-Specialty