Provider Demographics
NPI:1871763342
Name:HEALTHY KIDS,SC
Entity type:Organization
Organization Name:HEALTHY KIDS,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFAA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-478-4666
Mailing Address - Street 1:18210 LA GRANGE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7723
Mailing Address - Country:US
Mailing Address - Phone:708-478-4666
Mailing Address - Fax:708-478-8444
Practice Address - Street 1:18210 LA GRANGE RD STE 109
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7723
Practice Address - Country:US
Practice Address - Phone:708-478-4666
Practice Address - Fax:708-478-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty