Healthcare Provider Details

I. General information

NPI: 1538384706
Provider Name (Legal Business Name): ADVANCED REPRODUCTIVE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 W. 143RD ST. SUITE 120
ORLAND PARK IL
60467
US

IV. Provider business mailing address

5225 OLD ORCHARD RD SUITE 24A
SKOKIE IL
60077
US

V. Phone/Fax

Practice location:
  • Phone: 708-403-4210
  • Fax: 708-403-5272
Mailing address:
  • Phone: 847-966-8803
  • Fax: 847-966-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE CLAYTON
Title or Position: DIRECTOR OF FINANCE AND ADMINISTRAT
Credential:
Phone: 847-966-8803