PELE BOUTROUS DINA


Address: 415 N 9th St # 4w16, Springfield, IL 62702
Phone: 2175458000

PELE BOUTROUS DINA (NPI# 1275898116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1275898116
Entity Type Individual
Full Name PELE BOUTROUS DINA
Credential M.D
Practice Address 415 N 9th St # 4w16
Springfield
IL 62702
Mailing Address Po Box 19676
Springfield
IL 62794-9676
Practice Telephone 2175458000
Practice Fax Number 2177576844
Mailing Telephone 2175458000
Mailing Fax Number 2177576844
Enumeration Date 2012-07-06
Last Update Date 2018-05-16
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2080N0001X Pediatrics
Specialization: Neonatal-Perinatal Medicine
036-138186 IL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL STATE LICENSE 036-138186 01

Office Location

Street Address 415 N 9TH ST # 4W16
City SPRINGFIELD
State IL
Zip Code 62702

Providers in the same location

NPI Name Taxonomy Address Enumeration
1043776958 Julie Michelle Livingston Nurse Practitioner 415 N 9th St # 4w16, Springfield, IL 62702-5303 2019-02-15

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1457866519 Mohammad Jamal Uddin Ansari Internal Medicine 751 N Rutledge St Ste 400, Springfield, IL 62702 2017-12-11
1588105811 Mickey Graphia Surgery 701 N 1st St # D346, Springfield, IL 62702 2017-03-20
1376908913 Abdul Hannan Internal Medicine 315 W Carpenter St # B, Springfield, IL 62702 2015-12-28
1871986414 Rachel Hoselton Nurse Practitioner 400 N 9th St Fl 4, Springfield, IL 62702 2015-03-06
1548697774 Alyssa Wilson Behavioral Analyst 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 2013-10-02
1174965446 Amy Wilson Speech-Language Pathologist 2120 West Washington Street, Springfield, IL 62702 2013-07-26
1427327733 Brook D Croke Genetic Counselor, MS 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 2011-12-16
1629352604 Renae M Sanchez Pharmacist 3216 East Clearlake Ave, Springfield, IL 62702 2011-10-07
1982915302 William Leland Zelkovich Radiology 701 N 1st, Springfield, IL 62702 2010-06-30
1588993430 Lutheran Child and Family Services of Illinois Foster Care Agency 620 N. Walnut St., Springfield, IL 62702 2009-12-23
Find all providers in zip 62702

Taxonomy Information

Taxonomy Code 2080N0001X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics
Specialization Neonatal-Perinatal Medicine

Taxonomy Definition

A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1255623997 Venkata Sasidhar Majjiga Pediatrics 301 N 8th Street, Siu School of Medicine, Pediatrics, Room 3a169, Springfield, IL 62794 2011-05-13
1831212976 Douglas Terry Leonard Pediatrics 3355 River Bend Dr., Suite 220, Springfield, OR 97477-8800 2007-04-06
1992878169 Michael Adrian Colasurdo Pediatrics 3355 Riverbend Dr Ste 220, Springfield, OR 97477-8800 2006-11-16
1699861740 Saumitra Biswas Pediatrics 3801 S. National Avenue, 7th Floor, Springfield, MO 65807-5210 2006-10-05
1437116050 Ozark Neonatal Associates, Inc. Pediatrics 1235 E Cherokee Street, Springfield, MO 65804-2203 2006-04-27
1841835816 Stephanie Ann Barthelette Pediatrics 759 Chestnut St, Springfield, MA 01107-1619 2019-11-13
1275045171 Kelsey Southard Pediatrics 3801 S National Ave, Springfield, MO 65807-5210 2017-11-01
1841607389 Zaineh Alja'nini Pediatrics 1235 E Cherokee St, Springfield, MO 65804-2203 2014-07-16
1811242043 Khushbu Shukla Pediatrics 3801 S National Ave, Springfield, MO 65807-5210 2012-07-13
1346507001 Mohamed Farooq Ahamed Pediatrics 415 N 9th St, Suite 4w16, Springfield, IL 62702-5303 2012-04-19
Find all providers in SPRINGFIELD

Competitor

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City SPRINGFIELD
Zip Code 62702

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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