MUNDELEIN PEDIATRICS S.C. NPI 1336294800

NPI Information

  • NPI: 1336294800
  • Provider Name: MUNDELEIN PEDIATRICS, S.C.
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Organization
  • CLIA Number: 14D0673568
  • Address: 1170 E BELVIDERE RD
    SUITE 106
    GRAYSLAKE, IL
    ZIP 60030
  • Phone: (847) 548-7337

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NPI Details

MUNDELEIN PEDIATRICS, S.C. is an adolescent medicine pediatrics in Grayslake, IL. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. MUNDELEIN PEDIATRICS, S.C. NPI is 1336294800. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1170 E BELVIDERE RD
SUITE 106
GRAYSLAKE, IL
ZIP 60030-061
Phone: (847) 548-7337
Fax: (847) 548-9909

The provider's authorized official is Robert G. Malloy .
The authorized official title is Vice President and has the following contact phone number (847) 548-7337.

The CLIA number assigned to this NPI record is 14D0673568 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 1/24/2007 and was last updated on 8/22/2020.

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
12080A0000XPediatricsAdolescent MedicineILLINOISYes

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: 11/21/2025

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