Healthcare Provider Details

I. General information

NPI: 1104096031
Provider Name (Legal Business Name): AMERICAN WOMEN'S PROFESSIONAL GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 N WESTERN AVE
CHICAGO IL
60647-2017
US

IV. Provider business mailing address

2744 N WESTERN AVE
CHICAGO IL
60647-2017
US

V. Phone/Fax

Practice location:
  • Phone: 773-727-7726
  • Fax:
Mailing address:
  • Phone: 773-727-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RENLIN XIA
Title or Position: MANAGER
Credential: MD
Phone: 773-727-7726