Healthcare Provider Details

I. General information

NPI: 1235573197
Provider Name (Legal Business Name): GYNECOLOGY INSTITUTE OF CHICAGO LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1424
CHICAGO IL
60611-8700
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1424
CHICAGO IL
60611-8700
US

V. Phone/Fax

Practice location:
  • Phone: 312-929-9191
  • Fax: 312-566-8986
Mailing address:
  • Phone: 312-929-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036116334
License Number StateIL

VIII. Authorized Official

Name: DR. NICOLE WILLIAMS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-929-9191