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EXCELSIOR MEDICAL CENTER LTD NPI 1174709117


NPI Information

NPI: 1174709117
Provider Name: EXCELSIOR MEDICAL CENTER LTD
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 14D1075736

Address:
333 E IL ROUTE 83
SUITE 107
MUNDELEIN, IL
ZIP 60060
Phone: (847) 566-5556
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EXCELSIOR MEDICAL CENTER LTD is a pediatrics in Mundelein, IL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. EXCELSIOR MEDICAL CENTER LTD NPI is 1174709117. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

333 E IL ROUTE 83
SUITE 107
MUNDELEIN, IL
ZIP 60060-214
Phone: (847) 566-5556
Fax: (847) 566-8886

The provider's authorized official is Olga Ulyanova .
The authorized official title is Owner and has the following contact phone number (847) 566-5556.

The CLIA number assigned to this NPI record is 14D1075736 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/19/2008 and was last updated on 1/19/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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