MEDICARE: CONTEMPORARY OB/GYN CHICAGO, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1699382531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTEMPORARY OB/GYN CHICAGO, PLLC

Provider Business Mailing Address
First Line	:	8140 S SPAULDING AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2173
Country	:	US
Telephone Number	:	773-340-2546
Fax Number	:	773-340-2547

Authorized Official
Title or Position	:	OWNER, MEDICAL DIRECTOR
Name	:	DR. MIA E LAYNE
Credential	:	MD
Telephone Number	:	773-636-5341

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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