Healthcare Provider Details

I. General information

NPI: 1477718849
Provider Name (Legal Business Name): WOMENS HEALTHCARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST 505W
EVANSTON IL
60202-3439
US

IV. Provider business mailing address

800 AUSTIN ST 505W
EVANSTON IL
60202-3439
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-0434
  • Fax: 847-869-1831
Mailing address:
  • Phone: 847-869-0434
  • Fax: 847-869-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036072314
License Number StateIL

VIII. Authorized Official

Name: THOMAS HERRIGES
Title or Position: DOCTOR
Credential: MD
Phone: 847-869-0437