Healthcare Provider Details

I. General information

NPI: 1699787846
Provider Name (Legal Business Name): OB GYNE ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD STE 600
ARLINGTON HEIGHTS IL
60005-1533
US

IV. Provider business mailing address

121 S WILKE RD STE 600
ARLINGTON HEIGHTS IL
60005-1533
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-4122
  • Fax: 847-259-1571
Mailing address:
  • Phone: 847-259-4122
  • Fax: 847-259-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MARY KAY MIGLIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-259-4122