Provider Demographics
NPI:1932307998
Name:TWIN GROVE PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:TWIN GROVE PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KAPRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-362-0611
Mailing Address - Street 1:6 E PHILLIP RD
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1700
Mailing Address - Country:US
Mailing Address - Phone:847-362-0611
Mailing Address - Fax:847-362-0647
Practice Address - Street 1:6 E PHILLIP RD
Practice Address - Street 2:SUITE 1108
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1700
Practice Address - Country:US
Practice Address - Phone:847-362-0611
Practice Address - Fax:847-362-0647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E60964Medicare UPIN