Healthcare Provider Details

I. General information

NPI: 1689182859
Provider Name (Legal Business Name): VIOS FERTILITY INSTITUTE CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 N MILWAUKEE AVE FL 2
CHICAGO IL
60622-2015
US

IV. Provider business mailing address

1455 N MILWAUKEE AVE FL 2
CHICAGO IL
60622-2015
US

V. Phone/Fax

Practice location:
  • Phone: 773-435-9036
  • Fax: 773-770-4626
Mailing address:
  • Phone: 773-435-9036
  • Fax: 773-770-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA MARSHALL
Title or Position: DIRECTOF OF INSURANCE CREDENTIALING
Credential: RMC
Phone: 773-435-9036