Healthcare Provider Details

I. General information

NPI: 1982059275
Provider Name (Legal Business Name): VIOS FERTILITY INSTITUTE CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 N MILWAUKEE AVE
CHICAGO IL
60622-2015
US

IV. Provider business mailing address

2516 WAUKEGAN RD 370
GLENVIEW IL
60025-1774
US

V. Phone/Fax

Practice location:
  • Phone: 866-258-8467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number336.019128
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number336.050582
License Number StateIL

VIII. Authorized Official

Name: HANNAH JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 312-433-9324