Provider Demographics
NPI:1962419937
Name:ALL STAR PEDIATRICS, P.C.
Entity type:Organization
Organization Name:ALL STAR PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-352-4448
Mailing Address - Street 1:6410 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4642
Mailing Address - Country:US
Mailing Address - Phone:708-352-4448
Mailing Address - Fax:708-352-1052
Practice Address - Street 1:6410 JOLIET RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4642
Practice Address - Country:US
Practice Address - Phone:708-352-4448
Practice Address - Fax:708-352-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty