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Organization

CHILDRENS MEDICAL CENTER SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NADA AL DALLAL M.D. (PRESIDENT)
(773) 847-9004
Entity
Organization

Contact information

Practice address
1801 W 47TH ST, CHICAGO, IL 60609-3872
(773) 847-9004
(773) 847-9008
Mailing address
1801 W 47TH ST, CHICAGO, IL 60609-3872
(773) 847-9004
(773) 847-9008

Taxonomy

Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
IL
2080P0214X
Pediatric Pulmonology Physician
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0001636919
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/09/2007
Last updated
09/11/2025
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