Healthcare Provider Details

I. General information

NPI: 1063337426
Provider Name (Legal Business Name): IVY CHICAGO SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S DESPLAINES ST STE 101
CHICAGO IL
60661-5514
US

IV. Provider business mailing address

1301 N BROADWAY # 36686
LOS ANGELES CA
90012-1408
US

V. Phone/Fax

Practice location:
  • Phone: 858-925-5330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CIRILLO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 860-235-1246