Healthcare Provider Details

I. General information

NPI: 1174753735
Provider Name (Legal Business Name): LITTLE VILLAGE WOMENS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 W 26TH ST
CHICAGO IL
60623-4316
US

IV. Provider business mailing address

4230 W 26TH ST
CHICAGO IL
60623-4316
US

V. Phone/Fax

Practice location:
  • Phone: 773-277-2227
  • Fax: 773-522-5613
Mailing address:
  • Phone: 773-277-2227
  • Fax: 773-522-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036093278
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number036093278
License Number StateIL

VIII. Authorized Official

Name: DR. SONYA LETRECE THOMAS
Title or Position: DIRECTOR
Credential: MD
Phone: 773-277-2227