MEDICARE: TOGETHER WOMEN'S HEALTH MEDICAL GROUP OF ILLINOIS, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1912161100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOGETHER WOMEN'S HEALTH MEDICAL GROUP OF ILLINOIS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 35567
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0633
Country	:	US
Telephone Number	:	312-775-1100
Fax Number	:	312-775-1111

Provider Business Practice Location Address
First Line	:	900 N KINGSBURY ST
Second Line	:	SUITE 130N
City	:	CHICAGO
State	:	IL
Zip	:	60610-7432
Country	:	US
Telephone Number	:	312-775-1100
Fax Number	:	312-775-1111

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. NYKISHA JACKSON
Credential	:
Telephone Number	:	412-956-6748

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	08/07/2023

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