Healthcare Provider Details

I. General information

NPI: 1346434651
Provider Name (Legal Business Name): WOMENS WELLNESS WORLD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17850 KEDZIE AVE #2600
HAZEL CREST IL
60429-2058
US

IV. Provider business mailing address

PO BOX 555
HAZEL CREST IL
60429-0555
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-7780
  • Fax: 708-799-7830
Mailing address:
  • Phone: 708-799-7780
  • Fax: 708-799-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MONIQUE DENEEN JONES
Title or Position: PHYSICIAN
Credential: MD
Phone: 708-799-7780