Progressive Pediatrics

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036112854 Issued in IL

Legal business name

PROGRESSIVE PEDIATRICS

Practice address

215 Remington Blvd
Suite K
Bolingbrook, IL 60440-3656

Phone

(630) 378-1111

Fax

(630) 378-1112

NPI assigned

Jan 7, 2009

Organization subpart

No

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

Authorized official

Name

Ayezah Mir, M.D

Title

President

Phone

(630) 378-1111

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1962648386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 REMINGTON BLVD",
            "address_2": "SUITE K",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403656",
            "telephone_number": "630-378-1111",
            "fax_number": "630-378-1112"
        },
        {
            "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": "630-378-1111",
            "fax_number": "630-378-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "MIR",
        "authorized_official_first_name": "AYEZAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-378-1111",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036112854",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036089109",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; 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.