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Organization

PROGRESSIVE PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AYEZAH MIR M.D (PRESIDENT)
(630) 378-1111
Entity
Organization

Contact information

Practice address
215 REMINGTON BLVD, SUITE K, BOLINGBROOK, IL 60440-3656
(630) 378-1111
(630) 378-1112
Mailing address
215 REMINGTON BLVD, SUITE K, BOLINGBROOK, IL 60440-3656
(630) 378-1111
(630) 378-1112

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
036089109
IL
261QP2300X
Primary Care Clinic/Center
Primary
036112854
IL

Other

Enumeration date
01/07/2009
Last updated
01/07/2009
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