McHenry Pediatrics MD SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036087368 Issued in IL

Legal business name

MCHENRY PEDIATRICS MD SC

Practice address

3625 Municipal Dr
McHenry, IL 60050-5434

Phone

(815) 385-8560

Fax

(815) 385-8568

NPI assigned

Mar 16, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Taiwo M Fasehun, MDNPI 1902832397

Title

Provider

Phone

(815) 385-8560

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taiwo M Fasehun, M.D.

  • Pediatrics Physician
  • McHenry, IL
  • NPI 1902832397
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304035200000",
    "number": "1013158468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 MUNICIPAL DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600505434",
            "telephone_number": "815-385-8560",
            "fax_number": "815-385-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 MUNICIPAL DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600505434",
            "telephone_number": "815-385-8560",
            "fax_number": "815-385-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCHENRY PEDIATRICS MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2011-04-29",
        "status": "A",
        "authorized_official_last_name": "FASEHUN",
        "authorized_official_first_name": "TAIWO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "815-385-8560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036087368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036087368",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "05632223",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McHenry Medical Center SC
• McHenry Medical Center, S.C.
• McHenry Naprapathic Center, P.C.
• McHenry Optical LTD.
• McHenry Pathology Associates, S.C
• McHenry Radiologists and Imaging Associates SC
• McHenry Township Fire Protection District
• Michael McKay
• Taylor McKenna, MS
• Delorean McKinney, BEHAVIORAL HEALTH

• Pediatrics Physician in McHenry, IL
• Providers in McHenry, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.