Organization
LINCOLN PEDIATRIC CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANN EVIOTA RUIZ (DIRECTOR)
(773) 728-4784
Entity
Organization
Contact information
Practice address
5641 N LINCOLN AVE, CHICAGO, IL 60659-4921
(773) 728-4784
(773) 728-4759
Mailing address
5641 N LINCOLN AVE, CHICAGO, IL 60659-4921
(773) 728-4784
(773) 728-4759
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036085554
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085554
—
IL
Enumeration date
03/23/2006
Last updated
10/26/2012
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