Organization
MCHENRY PEDIATRICS MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAIWO M FASEHUN MD (PROVIDER)
(815) 385-8560
Entity
Organization
Contact information
Practice address
3625 MUNICIPAL DR, MCHENRY, IL 60050-5434
(815) 385-8560
(815) 385-8568
Mailing address
3625 MUNICIPAL DR, MCHENRY, IL 60050-5434
(815) 385-8560
(815) 385-8568
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036087368
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036087368
—
IL
01
—
05632223
BC/BS
IL
Enumeration date
03/16/2009
Last updated
04/29/2011
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