Provider Demographics
NPI:1053417741
Name:SUNSHINE PEDIATRICS, S.C.
Entity type:Organization
Organization Name:SUNSHINE PEDIATRICS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:UTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-587-9090
Mailing Address - Street 1:214 WASHINGTON ST
Mailing Address - Street 2:STE 3
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9208
Mailing Address - Country:US
Mailing Address - Phone:847-587-9090
Mailing Address - Fax:847-587-9093
Practice Address - Street 1:214 WASHINGTON ST
Practice Address - Street 2:STE 3
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9208
Practice Address - Country:US
Practice Address - Phone:847-587-9090
Practice Address - Fax:847-587-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932453OtherBLUE CROSS BLUE SHIELD