Healthcare Provider Details

I. General information

NPI: 1346376548
Provider Name (Legal Business Name): MIDWEST WOMEN'S HEALTH , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7456 S STATE RD SUITE 302
BEDFORD PARK IL
60638-6623
US

IV. Provider business mailing address

7456 S STATE RD SUITE 302
BEDFORD PARK IL
60638-6623
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-4100
  • Fax: 708-598-0123
Mailing address:
  • Phone: 708-598-4100
  • Fax: 708-598-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093184
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036093184
License Number StateIL

VIII. Authorized Official

Name: DR. FOUAD A. AL-QAWASMI
Title or Position: PRESIDENT
Credential: MD
Phone: 708-598-4100