Organization
CERMAK CHILDREN'S CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE THOMAS AMPALLOOR M.D. (PRESIDENT)
(847) 840-9714
Entity
Organization
Contact information
Practice address
6917 W CERMAK ROAD, BERWYN, IL 60804-2172
(708) 788-4933
(708) 788-5296
Mailing address
1044 N MOZART ST, STE - 402, CHICAGO, IL 60622-2789
(773) 292-4501
(773) 292-2613
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036105483
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105483
—
IL
Enumeration date
10/02/2012
Last updated
10/02/2012
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