Provider Demographics
NPI:1962643502
Name:J W MUSCADIN MD PEDIATRIC SERVICES INC
Entity type:Organization
Organization Name:J W MUSCADIN MD PEDIATRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSCADIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-874-3005
Mailing Address - Street 1:326 W 64TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3114
Mailing Address - Country:US
Mailing Address - Phone:773-874-3005
Mailing Address - Fax:773-962-4638
Practice Address - Street 1:326 W 64TH ST STE 303
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:773-874-3005
Practice Address - Fax:773-962-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-063960208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty