Provider Demographics
NPI:1962728386
Name:A TO Z PEDIATRIC AND YOUTH HEALTHCARE
Entity type:Organization
Organization Name:A TO Z PEDIATRIC AND YOUTH HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-757-4010
Mailing Address - Street 1:721 W LAKE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2035
Mailing Address - Country:US
Mailing Address - Phone:630-757-4010
Mailing Address - Fax:630-757-4011
Practice Address - Street 1:721 W LAKE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2035
Practice Address - Country:US
Practice Address - Phone:630-757-4010
Practice Address - Fax:630-757-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097752261QP2300X
IL042619155261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03-6097752Medicaid