Pediatric Urgent Care of Illinois, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036091219 Issued in IL

Legal business name

PEDIATRIC URGENT CARE OF ILLINOIS, LLC

Practice address

215 Remington Blvd
Suite K
Bolingbrook, IL 60440-3656

Phone

(630) 487-1556

NPI assigned

Oct 8, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Gerardo Reyes, M.D.

Title

Owner

Phone

(630) 487-1556

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381190400000",
    "number": "1922435890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5611 COLLEYVILLE BLVD STE 100",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760346069",
            "telephone_number": "817-485-6000",
            "fax_number": "214-276-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE K",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403656",
            "telephone_number": "630-487-1556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC URGENT CARE OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2013-10-08",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "GERARDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-487-1556",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036091219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milan Vijay Patel, DPM
• Munira Mamendra Patel
• Nilam Patel
• Patterson Medical Supply, Inc
• Patricia Paulson, BS
• Pendulum Counseling Services Corp
• Jason Scott Pequette, MS,ATC,CSCS
• John E Perch, DO
• Maiquel Perez
• Maritza Aidee Perez, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; 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.