Provider Demographics
NPI:1730334764
Name:NEIGHBORHOOD PEDICATRICS SC
Entity type:Organization
Organization Name:NEIGHBORHOOD PEDICATRICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYISICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLIPFEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-481-5570
Mailing Address - Street 1:20200 GOVERNORS DR
Mailing Address - Street 2:101
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1032
Mailing Address - Country:US
Mailing Address - Phone:708-481-5570
Mailing Address - Fax:
Practice Address - Street 1:20200 GOVERNORS DR
Practice Address - Street 2:101
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1032
Practice Address - Country:US
Practice Address - Phone:708-481-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360702192080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070219Medicaid