Healthcare Provider Details

I. General information

NPI: 1699985325
Provider Name (Legal Business Name): THE WOMENS PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST 825
CHICAGO IL
60611-2999
US

IV. Provider business mailing address

737 N MICHIGAN AVE 950
CHICAGO IL
60611-2615
US

V. Phone/Fax

Practice location:
  • Phone: 312-751-7515
  • Fax: 312-751-1208
Mailing address:
  • Phone: 312-751-7515
  • Fax: 312-751-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAQUE MCGINNIS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 312-751-7515