Provider Demographics
NPI:1548337793
Name:PEDIATRIC ASSOCIATES PC
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBASH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-6569
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0489
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:3749 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2019
Practice Address - Country:US
Practice Address - Phone:708-422-6569
Practice Address - Fax:708-499-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-073878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632846OtherBCBS
IL036073878Medicaid