Provider Demographics
NPI:1366874356
Name:RAVENSWOOD PEDIATRICS SC
Entity type:Organization
Organization Name:RAVENSWOOD PEDIATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:OCHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:872-208-6257
Mailing Address - Street 1:1945 W WILSON AVE STE 6116
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5259
Mailing Address - Country:US
Mailing Address - Phone:872-208-6257
Mailing Address - Fax:
Practice Address - Street 1:1945 W WILSON AVE STE 6116
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:872-208-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty