Healthcare Provider Details

I. General information

NPI: 1255453494
Provider Name (Legal Business Name): CHAMS WOMEN'S HEALTH CARE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W PETERSON AVE STE 101
CHICAGO IL
60646-6052
US

IV. Provider business mailing address

4600 W PETERSON AVE
CHICAGO IL
60646-5833
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-3404
  • Fax: 773-283-3548
Mailing address:
  • Phone: 773-283-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA RIDLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 773-283-3404