Provider Demographics
NPI:1871081430
Name:ENGLEWOOD PEDIATRICS SC
Entity type:Organization
Organization Name:ENGLEWOOD PEDIATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-874-3005
Mailing Address - Street 1:6307 S STEWART AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3116
Mailing Address - Country:US
Mailing Address - Phone:773-874-3005
Mailing Address - Fax:773-874-3305
Practice Address - Street 1:6307 S STEWART AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-874-3005
Practice Address - Fax:773-874-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-28
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-097206Medicaid