Organization
CHICAGO PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE EGUES M.D. (OWNER PRESIDENT)
(773) 477-4900
Entity
Organization
Contact information
Practice address
1918 W IRVING PARK RD, CHICAGO, IL 60613-2408
(773) 477-4900
(773) 477-4478
Mailing address
777 OAKMONT LN, SUITE 1600, WESTMONT, IL 60559-5511
(630) 789-2550
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632128
BCBS PROVIDER ID
IL
01
—
201026
ADVOCATE HLTH PRTNRS ID
IL
Enumeration date
02/07/2007
Last updated
07/21/2022
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