Organization
FOX RIVER PEDIATRICS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYEZAH MIR MD (OWNER)
(630) 926-4471
Entity
Organization
Contact information
Practice address
11000 US HIGHWAY 34, SUITE 3, PLANO, IL 60545-9824
(630) 552-9852
(630) 552-9857
Mailing address
11000 US HIGHWAY 34, SUITE 3, PLANO, IL 60545-9824
(630) 552-9852
(630) 552-9857
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-112854
IL
Other
Enumeration date
08/28/2009
Last updated
09/05/2011
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