Organization
ABC PEDIATRICS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUS A ROUSONELOS M.D. (OWNER)
(630) 355-0003
Entity
Organization
Contact information
Practice address
1331 W 75TH STREET, SUITE 300, NAPERVILLE, IL 60540
(630) 355-0003
(630) 355-9822
Mailing address
1331 W 75TH STREET, SUITE 300, NAPERVILLE, IL 60540
(630) 355-0003
(630) 355-9822
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042.618674
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02201648
BC BS PROVIDER NUMBER
IL
01
—
042.618674
REGISTERED MEDICAL CORP
IL
01
—
14D0866815
CLIA WAIVER CERT
—
Enumeration date
04/06/2007
Last updated
05/02/2019
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