Provider Demographics
NPI:1306050943
Name:HIGHLAND PARK PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:HIGHLAND PARK PEDIATRIC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPING RECEPTION
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-432-8422
Mailing Address - Street 1:1160 PARK AVE W
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:847-432-8422
Mailing Address - Fax:847-432-9480
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:SUITE 3E
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2230
Practice Address - Country:US
Practice Address - Phone:847-432-8422
Practice Address - Fax:847-432-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN