Healthcare Provider Details

I. General information

NPI: 1487650982
Provider Name (Legal Business Name): WOMANCARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W PROSPECT AVE
MT PROSPECT IL
60056-3136
US

IV. Provider business mailing address

221 W PROSPECT AVE
MT PROSPECT IL
60056-3136
US

V. Phone/Fax

Practice location:
  • Phone: 847-221-4800
  • Fax: 847-221-4896
Mailing address:
  • Phone: 847-221-4800
  • Fax: 847-221-4896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CARL DAVID CUCCO
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 847-221-4800