GRACE PEDIATRICS LLC NPI 1801120860

NPI Information

  • NPI: 1801120860
  • Provider Name: GRACE PEDIATRICS LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 14D2028638
  • Address: 1118 BLOOMINGDALE RD
    GLENDALE HEIGHTS, IL
    ZIP 60139
  • Phone: (630) 784-8600

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NPI Details

GRACE PEDIATRICS LLC is a primary care clinic center in Glendale Heights, IL. GRACE PEDIATRICS LLC NPI is 1801120860. The provider is registered as an organization entity type.

The provider's business location address is:

1118 BLOOMINGDALE RD
GLENDALE HEIGHTS, IL
ZIP 60139-498
Phone: (630) 784-8600
Fax: (630) 456-4086

The provider's authorized official is Arjumand Farhana .
The authorized official title is Physician and has the following contact phone number (312) 933-8446.

The CLIA number assigned to this NPI record is 14D2028638 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/23/2009 and was last updated on 3/27/2012.

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
1261QP2300XClinic/CenterPrimary Care036106640ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
136106640MEDICAIDILLINOIS

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: 3/30/2025

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