Organization
BACK TO BASICS PEDIATRICS SC
Active
Other names
Back to Basics Pediatrics, S Corp
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTINE POULOS MD (PEDIATRICIAN)
(224) 520-0087
Entity
Organization
Contact information
Practice address
2403 HARNISH DR STE 101, ALGONQUIN, IL 60102-6803
(224) 520-0087
Mailing address
2403 HARNISH DR STE 101, ALGONQUIN, IL 60102-6803
(224) 333-0730
(224) 333-0748
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
09/24/2018
Last updated
12/12/2018
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