Healthcare Provider Details

I. General information

NPI: 1508060146
Provider Name (Legal Business Name): ADVANCED HEALTHCARE FOR WOMEN,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WILLOW SPRINGS RD STE 120
LA GRANGE HIGHLANDS IL
60525-6540
US

IV. Provider business mailing address

5201 WILLOW SPRINGS RD STE 120
LA GRANGE HIGHLANDS IL
60525-6540
US

V. Phone/Fax

Practice location:
  • Phone: 708-579-0974
  • Fax: 708-579-1402
Mailing address:
  • Phone: 708-579-0974
  • Fax: 708-579-1402

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: DR. SCOTT M. MULTACK
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 708-579-0974