Healthcare Provider Details

I. General information

NPI: 1073677589
Provider Name (Legal Business Name): CHICAGO WOMEN'S HEALTH, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE 1410
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

30 N MICHIGAN AVE 1410
CHICAGO IL
60602-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-726-7272
  • Fax: 312-899-8382
Mailing address:
  • Phone: 312-726-7272
  • Fax: 312-899-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. LESLEY COWAN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 312-726-7272