CRYSTAL LAKE CLINIC – NPI #1124362306
Pediatrics

A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease.

Health Care Provider Taxonomy Code for Pediatrics

CRYSTAL LAKE CLINIC is a provider located in CRYSTAL LAKE, IL. NPPES has assigned the NPI number 1124362306 to CRYSTAL LAKE CLINIC on November 12, 2012. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “CRYSTAL LAKE CLINIC” is a dba name, the actual legal business name for this organization is CHILDREN'S PHYSICIAN GROUP. The primary taxonomy selected by this provider is 2080P0202X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Pediatric Cardiology

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CRYSTAL LAKE CLINIC below.

NPI Profile for
CHILDREN'S PHYSICIAN GROUP

NPI Number
1124362306
Enumeration Date

(more than 13 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CHILDREN'S PHYSICIAN GROUP
Doing Business As (dba): CRYSTAL LAKE CLINIC
Primary location
360 STATION DR
CRYSTAL LAKE, IL 60014-7978
Phone: (815) 338-6600 Fax: (815) 477-9826
Mailing address
9000 W WISCONSIN AVE
MS 958
MILWAUKEE, WI 53226-4874
Phone: (414) 266-7615 Fax: (414) 266-6238
Organization Subpart
Yes - CRYSTAL LAKE CLINIC is subpart of another organization.
Authorized Official
SMRITI KHARE
PRESIDENT, CHILDREN'S PHYSICIAN GRP
Phone: (414) 266-7615
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2080P0202X
- Pediatrics / Pediatric Cardiology (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.