Healthcare Provider Details

I. General information

NPI: 1821330747
Provider Name (Legal Business Name): MIDWEST CENTER FOR WOMEN'S HEALTH CARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 OLD ORCHARD CTR STE 200
SKOKIE IL
60077-1462
US

IV. Provider business mailing address

601 SKOKIE BLVD STE 400
NORTHBROOK IL
60062-2820
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-3130
  • Fax: 847-673-3183
Mailing address:
  • Phone: 847-562-1410
  • Fax: 847-562-0830

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: ERIC BRODSKY
Title or Position: DIRECTOR, BILLING AND OPERATIONS
Credential:
Phone: 847-562-1410