NPIMap

Organization Active NPI

Mundelein Pediatrics, S.C.

  • Pediatric Adolescent Medicine Physician
  • Grayslake, IL
National Provider Identifier
1336294800
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
MUNDELEIN PEDIATRICS, S.C.
Practice address
1170 E Belvidere Rd
Suite 106
Grayslake, IL 60030-2061
Phone
(847) 548-7337
Fax
(847) 548-9909
NPI assigned
Jan 24, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert G. Malloy, M.D.NPI 1922092048
Title
Vice President
Phone
(847) 548-7337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X IL Primary

Addresses

Primary practice location

1170 E Belvidere Rd
Suite 106
Grayslake, IL 60030-2061

Mailing address

1170 E Belvidere Rd
Suite 106
Grayslake, IL 60030-2061
Phone (847) 548-7337

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0673568Mundelein Pediatrics SC1170 East Belvidere Road #106, Grayslake, IL 60030Provider-performed microscopyJul 31, 2026

National Provider Directory

National Provider Directory

Locations

1170 E Belvidere Rd
Grayslake, IL 60030
Phone (847) 223-0127

1170 E Belvidere Rd
Ste 106
Grayslake, IL 60030
Phone (847) 548-7337

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336294800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1170 E BELVIDERE RD",
            "address_2": "SUITE 106",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302061",
            "telephone_number": "847-548-7337",
            "fax_number": "847-548-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1170 E BELVIDERE RD",
            "address_2": "SUITE 106",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302061",
            "telephone_number": "847-548-7337",
            "fax_number": "847-548-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNDELEIN PEDIATRICS, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALLOY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "847-548-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.