Healthcare Provider Details

I. General information

NPI: 1265529903
Provider Name (Legal Business Name): FERTILITY CENTERS OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 PATRIOT BLVD. SUITE 200
GLENVIEW IL
60026
US

IV. Provider business mailing address

2555 PATRIOT BLVD. SUITE 200
GLENVIEW IL
60026
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-8200
  • Fax: 847-998-6880
Mailing address:
  • Phone: 847-998-8200
  • Fax: 847-998-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number042007296
License Number StateIL

VIII. Authorized Official

Name: KIRSTIN RUNA
Title or Position: MANAGING PARTNER OF BUSINESS OPERAT
Credential:
Phone: 720-810-0707