Healthcare Provider Details

I. General information

NPI: 1982600466
Provider Name (Legal Business Name): GYNECOLOGICAL & OBSTETRIC ASSOCS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W CENTRAL RD STE 205
ARLINGTON HTS IL
60005
US

IV. Provider business mailing address

675 W CENTRAL RD STE 100A
ARLINGTON HTS IL
60005-2374
US

V. Phone/Fax

Practice location:
  • Phone: 847-392-9191
  • Fax: 847-392-9811
Mailing address:
  • Phone: 847-392-9191
  • Fax: 847-392-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: LORRAINE S NOVAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-392-9174