Healthcare Provider Details

I. General information

NPI: 1710803978
Provider Name (Legal Business Name): THE PELVIC HEALTH INSTITUTE OF ILLINOIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5851 W 95TH ST STE 300
OAK LAWN IL
60453-2415
US

IV. Provider business mailing address

5851 W 95TH ST STE 300
OAK LAWN IL
60453-2415
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA JOHNSON
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 708-499-9800