# CHICAGOLAND UNIVERSITY PEDIATRIC SURGERY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245746213
- **Authorized official:** JAMES NOBLE (REVENUE MANAGER)
- **Authorized official phone:** (630) 424-1122

## Contact information

- **Practice address:** 2900 N LAKE SHORE DR, CHICAGO, IL 60657-5640
- **Practice address phone:** (773) 665-3000
- **Mailing address:** 13400 S ROUTE 59 STE 116-208, PLAINFIELD, IL 60585-5826
- **Mailing address phone:** (630) 424-1122
- **Mailing address fax:** (630) 396-2677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0120X | Pediatric Surgery Physician | — | NULL | Yes |
| 2086S0120X | Pediatric Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/28/2017
- **Last updated:** 12/28/2017