NPIMap

Organization Active NPI

Children's Physician Group

  • Pediatric Dermatology Physician
  • Evanston, IL
National Provider Identifier
1356517221
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
Legal business name
CHILDREN'S PHYSICIAN GROUP
Practice address
2500 Ridge Ave
Suite 109
Evanston, IL 60201-2455
Phone
(847) 662-4380
Fax
(847) 662-3557
NPI assigned
May 1, 2008
Organization subpart
Yes
Parent organization
CHILDREN'S PHYSICIAN GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Dr. Thomas Dunigan, MD
Title
President, Children's Physician GRP
Phone
(414) 266-7615

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207NP0225X Primary

Addresses

Primary practice location

2500 Ridge Ave
Suite 109
Evanston, IL 60201-2455

Mailing address

9000 W Wisconsin Ave
Ms 8000
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other names 1

  • Evanston Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Children's Physician GRP PC8 organizations share this tax ID, including this one
Part of
Children's Physician GRP PC

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1356517221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MS 8000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-3803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIDGE AVE",
            "address_2": "SUITE 109",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602012455",
            "telephone_number": "847-662-4380",
            "fax_number": "847-662-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S PHYSICIAN GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S PHYSICIAN GROUP",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "DUNIGAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT, CHILDREN'S PHYSICIAN GRP",
        "authorized_official_telephone_number": "414-266-7615",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evanston Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.