Organization
CHILDREN'S PHYSICIAN GROUP
Active
Parent organization
CHILDREN'S PHYSICIAN GROUP
Other names
Crystal Lake Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S PHYSICIAN GROUP
Authorized official
DR. SMRITI KHARE MD (PRESIDENT, CHILDREN'S PHYSICIAN GRP)
(414) 266-7615
Entity
Organization
Contact information
Practice address
360 STATION DR, CRYSTAL LAKE, IL 60014-7978
(815) 338-6600
(815) 477-9826
Mailing address
9000 W WISCONSIN AVE, MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Enumeration date
11/12/2012
Last updated
11/12/2012
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