Healthcare Provider Details

I. General information

NPI: 1851429054
Provider Name (Legal Business Name): OBSTETRIC & GYNECOLOGIC ULTRASOUND.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 1430
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1430
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-654-9100
  • Fax: 312-654-9202
Mailing address:
  • Phone: 773-735-2110
  • Fax: 773-735-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036052551
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036052551
License Number StateIL

VIII. Authorized Official

Name: DR. RUDY E SABBAGHA
Title or Position: MEDICAL DIRECTOR
Credential: MD,FACOG
Phone: 312-654-9100