Provider Demographics
NPI:1194941757
Name:FAIRVIEW PEDIATRICS LLC
Entity type:Organization
Organization Name:FAIRVIEW PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRAKORA-LOOBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-548-8777
Mailing Address - Street 1:1475 E BELVIDERE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2016
Mailing Address - Country:US
Mailing Address - Phone:847-548-8777
Mailing Address - Fax:847-548-8899
Practice Address - Street 1:1475 E BELVIDERE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2016
Practice Address - Country:US
Practice Address - Phone:847-548-8777
Practice Address - Fax:847-548-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Not Answered291U00000XLaboratoriesClinical Medical Laboratory