Healthcare Provider Details

I. General information

NPI: 1033525191
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 10/21/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N WABASH STREET SUITE 500
CHICAGO IL
60602-3200
US

IV. Provider business mailing address

17 N STATE ST STE 500
CHICAGO IL
60602-3384
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6700
  • Fax: 312-592-6701
Mailing address:
  • Phone: 312-592-6800
  • Fax: 312-592-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209009336
License Number StateIL

VIII. Authorized Official

Name: ERIKA R GONZALEZ
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 312-592-6892