Healthcare Provider Details

I. General information

NPI: 1992933782
Provider Name (Legal Business Name): JESSICA L. FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N. RANDALL ROAD, SUITE 309 MIDWEST CENTER FOR WOMEN'S HEALTHCARE
ELGIN IL
60123
US

IV. Provider business mailing address

2801 LAKESIDE DR STE 209
BANNOCKBURN IL
60015-1271
US

V. Phone/Fax

Practice location:
  • Phone: 847-741-7990
  • Fax: 847-741-8099
Mailing address:
  • Phone: 847-562-1410
  • Fax: 847-562-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301094739
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-132975
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: