Healthcare Provider Details

I. General information

NPI: 1104633866
Provider Name (Legal Business Name): SURGERY CENTER FOR HUMAN REPRODUCTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 100
CHICAGO IL
60611-4447
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 117
CHICAGO IL
60611-4448
US

V. Phone/Fax

Practice location:
  • Phone: 312-288-6420
  • Fax:
Mailing address:
  • Phone: 312-288-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BETH ZONERAICH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-834-7227