Unknown Individual – Pediatric Adolescent Medicine Physician, NPI 1548269814
Pediatric Adolescent Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
PO BOX 189
MATTESON, IL 604430189
Phone: (708) 747-5850
Fax: (708) 747-9991
Type: Mailing
Gold Coast Galleria, 1004-1030, North Clark Street, Gold Coast, Near North Side, Chicago, Cook County, Illinois, 60610, United States
SUITE 400
CHICAGO, IL 606105467
Phone: (312) 943-6964
Fax: (312) 943-6924
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60443)
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