1407194780 NPI number — WELL BABY CARE PC

Table of content: (NPI 1407194780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407194780 NPI number — WELL BABY CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELL BABY CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407194780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1185-87 DUNDEE AVENUE
Provider Second Line Business Mailing Address:
SUITE A-2
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-608-9481
Provider Business Mailing Address Fax Number:
847-608-9483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1185-87 DUNDEE AVENUE
Provider Second Line Business Practice Location Address:
SUITE A-2
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-608-9481
Provider Business Practice Location Address Fax Number:
847-608-9483
Provider Enumeration Date:
01/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MISRA
Authorized Official First Name:
SHARMITA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN, OWNER
Authorized Official Telephone Number:
847-608-9481

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  036-085278 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080N0001X , with the licence number: 036-085278 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036-085278 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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