Healthcare Provider Details

I. General information

NPI: 1417075748
Provider Name (Legal Business Name): ADVANCED OB GYNE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 BARRINGTON RD SUITE 605
HOFFMAN ESTATES IL
60194-1090
US

IV. Provider business mailing address

1585 BARRINGTON RD SUITE 605
HOFFMAN ESTATES IL
60194-1090
US

V. Phone/Fax

Practice location:
  • Phone: 847-755-1111
  • Fax: 847-755-1166
Mailing address:
  • Phone: 847-755-1111
  • Fax: 847-755-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN MARY SHAW
Title or Position: MANAGER
Credential:
Phone: 847-755-5588