Healthcare Provider Details

I. General information

NPI: 1477611028
Provider Name (Legal Business Name): WOMENS SPECIALTY CARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WAUKEGAN RD STE 208
LAKE FOREST IL
60045-2619
US

IV. Provider business mailing address

475 MCCORMICK DR
LAKE FOREST IL
60045-3349
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-0433
  • Fax: 847-234-0034
Mailing address:
  • Phone: 847-295-0433
  • Fax: 847-295-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036093085
License Number StateIL

VIII. Authorized Official

Name: DR. KAREN J MASS
Title or Position: PRESIDENT
Credential: MD
Phone: 847-295-0433