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Organization
CHILD & ADOLESCENT HEALTH ASSOC LTD
Active
Organization
CHILD & ADOLESCENT HEALTH ASSOC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALETA CLARK M.D. (PRESIDENT)
(312) 943-6964
Entity
Organization
Contact information
Practice address
1030 N CLARK ST, SUITE 400, CHICAGO, IL 60610-5467
(312) 943-6964
(312) 943-6924
Mailing address
PO BOX 189, MATTESON, IL 60443-0189
(708) 747-5850
(708) 747-9991
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051208
—
IL
Enumeration date
10/24/2005
Last updated
11/25/2009
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